Finding a Better Way with Satori Health | Cherry Live!

This in depth look at the Satori model, what has worked well and where have there been challenges - gives hope for a patient centric collaborative approach that our system has been calling for.

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About the Event

After learning about Satori Health and their vision to change health care, for good we needed to learn more! We recently sat down for a conversation with Stephen Torriero, the Clinic Integration Manager for Satori Health.

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This episode of Cherry Live investigated Satori's approach to create a better way forward by building a collection of practitioners and clinics to create a collaborative network model. This team-based approach to care has been identified as a critical step in the right direction however putting it into practice can be a challenge.

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Watch our full webinar to learn more about Satori and also to engage in this critical conversation about how clinics and healthcare are shifting.

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Objectives and Discussions

• How clinics and health care are shifting
• What is the Satori method?
• Successes and challenges of the Satori method

More Resources:

LinkedIn: https://cherryhealth.co/linkedin

Facebook: https://www.facebook.com/cherryhealthinc/

Instagram: @cherry.health

Twitter: @cherryhealthinc

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Have questions? We want to hear them!

Feel free to reach out on any of our platforms and join the conversation.

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Transcript

Speaker Identification:

[Host]: Alitta Tait

[Speaker]: Stephen Torriero

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Alitta: Hello and welcome to this episode of Cherry Live. I'm A and those of you for tuning in for the first time on a Cherry Live is brought to you by Cherry Health, Canada's medical network with healthcare practitioners all across Canada where they go to connect. If you haven't logged on to our site before, we're the number one largest platform on Canada for physician jobs, featuring opportunities from thousands of clinicsospitals and virtual care clinics across the country. And if you're on the other side of the table, looking for talent to join your team, it's actually free to post your jobs and connect with the physicians all across the country. If you wanna check out the site, it's www.cherry.health, and you can sign up today for free and start connecting. Today, we're joined by Steven Torriero from Satori Health. Satori is made up of nine clinics today in Alberta, but just getting startedI'm excited to discuss their vision for healthcare and how creating this network of clinics with focus on practitioners collaboration and work-life balance is gonna make a difference. No doubt these are great hopes to have and today we're looking forward to dig in into how they're making that happen. If you have any questions today during the course of the chat, please pop them into the chat section on the right hand side, we'd love to hear from you, see where you're tuning in from in that kind of jazz.So thank you for joining us today, Stephen. Would love to learn a little bit about you and what got you to working for Satori Health.

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Stephen: Yeah, no, thanks, really, I appreciate it. Yeah, it's been a it's been really a lot of fun working with the cherry team over the last few months. So thanks for having me on. Yeah, so Satori, I've been with the company for just under a year now. I joined last fall and in a business development kind of lead. I handle all of our clinical acquisitions and physician recruitment, stuff like that. Soit's been great. It's just really the, obviously the, you know, I think what drew me to Satori was, was obviously the team, just great people to work with and, and obviously a great vision and something that, that I think we're all striving for. And so to be able to be, you know, part of that solution, you know, hopefully is exciting and yeah, we're definitely working towards it. So no, it's been fun, yeah.

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Alitta: Amazing. So tell us a little, I mean, you mentioned the team and that's what drew you to join. So tell us a little bit from, I mean, you're on the more corporate side of the equation at Satori, but from that, I think that kind of culture, you know, exudes out into the rest of the organization. So from your perspective at Satori, tell us a little bit about what it's like to be a part of that team. What is the culture at Satori from a corporate perspective?

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Stephen: Yeah, no, great. Yeah, great point. Well, we've, it's funny, we found that that, you know, the medical industry and healthcare really doesn't have a proper culture. Everyone's kind of stuck in their own little, their own clinics, and there's not much interaction or collaboration or fun for that matter. So we're really trying to kind of change that. And kind of bring everyone together, like all of our physicians and practitioners, we try to meet regularly and try to do a lot of, bonding and different activities and stuff and events. So we are trying to kind of change that and it's been a lot of fun and it's been received pretty well. So hopefully that will carry on and carry out into the rest of the industry and the province.

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Alitta: Yeah, and so tell us, so you all are based in Calgary, correct, I've been to that, the home office one time, it was really awesome, but you guys are in Calgary. And tell us so far a little bit about the clinics and the makeup of that network so far.

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Stephen: Yeah, so Satori Health has been around for a few years now. It started off as like an e-consult platform for cannabis prescribing initially. And then we started buying several clinics. And then in the meantime, we've developed that e-consultation platform and it's become a lot more comprehensive and collaborative and I'll obviously get into that a little more, but, and so now, yeah, we have nine clinics, as you mentioned. So we, yeah, we own clinics, manage clinics. We also have clinics that we're enrolling into our into our collaborative health program, is what we call it. Which is that virtual platform I mentioned. So a lot of ways to kind of get involved. And yeah, it's really just, we're really trying to build, you know, an entire health network with, you know, primary care, secondary care. We just brought on a urologist into one of our clinics, Dr. Anthony Cook at our Greenview location. So we're getting into specialty. And obviously Allied Health, you know, we've partnered with Elevation Mental Health, and we're bringing on physiotherapy in the fall here. So yeah, just continuously growing and adding to that network, you know, both in person and as well as on that virtual platform. Yeah.

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Alitta: Yeah, and you mentioned these different types of practitioners and the word network and that kind of thing a bit. So tell us a little bit about the Satori vision of having, you know, multi-practitional type practices or type locations and team based care.

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Stephen: Yeah, exactly. That's exactly what it is. We're really trying to address, you know, and I'm sure we all have different opinions of what needs to change. And then there's a lot that needs to be addressed. But we're really trying to change the paradigm and really trying to, you know, I guess, provide solutions to how healthcare is delivered. And we're continuously evolving and, and finding creative ways to make that happen through innovative technology and, you know, efficient workflows within our software. And like you mentioned, the team approach. I think it's, it's critical moving forward. There's just simply not enough physicians to care for our patients. We've, we've heard numbers like, 30% of family physicians will be retiring in the next five years. And, you know, those more senior physicians will obviously hold a disproportionate amount of the patient population. So just a ton of people are going to need family doctors soon. So we need to find ways to really utilize our physicians' really valuable time and expertise and really try to optimize their capacities as best we can.

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Alitta: Well, and it seems as well, you know, that using the physician's expertise where it serves, but then perhaps an RN or a nurse practitioner in other spaces and the mental health professionals where that makes sense so that you're really tapping into that expertise within those different skill sets instead of trying to make that primary care, that physician be everything to everyone all the time.

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Stephen:No, exactly. Exactly. And we want our physicians to just focus on, you know, what they were trained to do, which is we just care for their patients. We don't want them bogged down with administrative duties. And so, we really try to take all of that off their plate. For in-clinic physicians, we have, you know, we have, I believe, 14, 15 nurse practitioners at our clinic. So, it might bethe highest employer of nurse practitioners outside of AHS. And then, yeah, so for in-clinic physicians, we have entire billing and referral teams that handle all of that. Obviously, you know, administrative teams and MOAs that try to take a lot off their plate as well. So yeah, we're definitely trying to, oour physicians as best we can. And just, you know, at the same time, we're considering that work-life balance and providing more services for our patients, which equates to more building opportunities for our physicians. And then, you know, they don't have to see 50 patients a day. We can, we can really try to, try to providea quality experience for our patients where physicians are still being compensated properly.

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Alitta: Right. Yeah, I mean, that ultimately is the goal, right? Like that patient experience, that they get that collaborative approach of support as well. They're talking to the right person at the right time and being able to move through those practitioners effectively too, which I think is a really strong approach that Satori has, is being able to do that.

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Stephen: Exactly. And then so yeah, like, some of the key kind of concerns we're trying to address within the industry. And like I said, there's lots and we're hopefully, you know, it's not, we're not fixing everything, but we're hopefully at the step in the right direction. And it's just, it's the siloed expertise, the reactive care, obviously, physician burnout, and the work-lifelack of patient empowerment and continuity. This company was built from a patient's perspective and we find it hard even myself to navigate the system. So somebody maybe perhaps less resourceful, like it's just it's really hard for patients to navigate the system right now. And so providing support there, you know, providingcollaboration for our physicians and really looking at a proactive preventative model where we are maintaining our patients' well-being, not just treating illness. I think that's a huge thing that needs to be a shift in that mentality. And with that comes huge cost savings to the system. I think there was a study done by Kaiser Permanente in the U.S.where $1 spent on primary care saved $8 downstream on secondary tertiary care. So it is significant and it's something that needs to be looked at.

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Alitta: So with the nine clinics that you have so far, tell us a little bit, what is the size? How many physicians do you have across Alberta so far? And those, like 15 NPs, I think that is a lot of NPs just in Alberta alone, but tell us a little bit and break down from the practitioner side.

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Stephen: For sure. So we have, I believe, 35, maybe getting close to 40 come this fall of in-clinic physicians. And then we have 40 specialists on our collaborative health platform that provide feedback and recommendations for our physicians. And then, yeah, I believe the team as a whole is over 200 at Satori Health. Yeah, so we're growing. The numbers keep, it's funny, we just had a big barbecue, an annual barbecue a few weeks ago, and it's just every year it seems like it doubles. So it's exciting.

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Alitta: So tell me a little bit more about this specialist on the platform and how that works.

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Stephen: Yeah, so I guess it's the easiest way to explain it is a physician at Satori, their practice is basically broken up into two components. There's your in-clinic practice, where we're fairly hands-off. Like I said, we provide the centralized services that handle all the billing and referrals and a lot of the admin work. And then there's our collaborative health program that we've developed. And that's actually driven by a proprietary software that we've developed internally that drives that efficient workflow. And what happens is we actually pair all of our physicians one-to-one with what we call a health plan coordinator, who are LPNs, basically with patient navigators, and they provide all of the follow-up and education and support, they're the patient's main point of contact. They have access to a patient portal that has all of their feedback from specialists and education and that's a communication tool with the LPN. So those LPNs also what they do is when they're paired with a physician, they'll do a full intake of all of the, their physician's entire panel. And so for you, Alita, we would do a full A to Z, head to toe, you know, would look through your charting, your net care, find allhealth concerns, and then they'll create health plans for each of those health concerns. And then those health plans are sent up to the panel of specialists for recommendation and advice and then sent back to the physician, which they can choose to use or not. Their previous history and grab all the information that's going to be relevant and really, you know, helpful for any practitioners to understand that patient more effectively. I think that's really, really cool. That's a really interesting opportunity, I think, for both patients and for practitioners on that side too. And then, you know, patients also have some peace of mind knowing that they're, they're being looked at their files are being looked at by a specialist and that also we've noticed, you know, in Alberta, there's some wait times to see a specialist in person 18 to 24 months. And, and then you find out when you get there that you weren't surgical and what kind of health issues have developed within that time of you waiting. So if you can get some immediate feedback from a specialist just to find out that maybe you don't need to see the specialist in person is huge and then you know, that's reducing wait times as well and taking some ease off the system. So yeah, it's kind of considering all of that. Patients are feeling, you know, more empowered and you know, more involved in their health journey. I think we try to help allow them to consult with their physician and decide what their priorities are and what they would like to have addressed maybe and in what order.

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Alitta: Absolutely. Well, and that I know Satori is pretty clear about their mission. You know, it's addressing the root causes of the system's dysfunctions and watching out for that physician burnout and practitioner burnout and some other aspects. But tell me a little bit, I think this is, you know, one of the number one issues that physicians face right now. And we know from the surveys that burnout is really, really hindering the ability for physicians to practice long term and their desire to leave. So tell me a little bit about how Satori is really focusing on that and some of the different ways that you guys try and alleviate that pressure off physicians.

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Stephen: Sure. So again, I think it comes down to just having that team approach and not having everything put onto the physician. So all of this, this whole collaborative platform is all managed and run by the LPN. So the physician has really minimal involvement aside from reviewing questions sent to the specialist and receiving that feedback. It's all done by the DLPN. Again, it's providing that additional revenue stream so that perhaps they can maybe be less involved in clinic and reduce their hours there. So I think that's where we're seeing the effect of it. Obviously we provide a lot.

Alitta: Well, and you mentioned something really interesting, which is that because they have some additional revenue streams and that you guys are focused on that and creating those efficiencies within the clinic, they're able to consider having manageable hours. It's not only to diminish their hours, but even just having manageable hours. I think, you know, for a lot of clinics the business model is really challenging right now because it's so competitive to get physicians, but at an 80-20 split, you know, where there's not a ton of these different types of programs, it can be really difficult to keep a clinic afloat and to run a business without physicians having to work just non-stop and driving those hours. So I think this is a really interesting and innovative way that you can say, Hey, we want to focus on burnout, but you can also make it work as a business because, hey, for the businesses of work, it all falls apart anyway.

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Stephen:No, exactly, exactly. Yeah, no, I'm glad you mentioned that. Yeah, it's a huge, huge problem we're seeing. And we're having a lot of clinical owners come to us and just say they're just getting by. And like you said, when physicians are bouncing from clinic to clinic and just squeezing that margin so thin and now we're seeing even like 85, 15 splits, like there's just no way a clinician operate with those splits. And then like MOAs are just with inflation, grocery prices are going up, rent's going up and their salaries are staying the same. There's no way to provide our physicians with the right support under that model. And so what we have to do is, because obviously physicians can't take less money, we just have to provide more services for our patients. And then, like I said, with that comes more billing opportunities.

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Alitta: Yeah, and a great patient experience. And so it really is that win-win as well. And so, you know, trying to pinch the envelope on one side or the other, it's really making sure that this works holistically so that it's a long-standing opportunity for the business too. So, tell me a little bit, I mean, so interestingly, I was in Toronto at an event a few months ago and was chatting with physicians, you know, all over, that are all over the country. But right now we see that Alberta is a pretty interesting place for physicians to come or for period because Calgary and Alberta has a pretty interesting draw right now with the cost of living and stuff like that. But I was chatting with a physician at this event and she said, oh I'm moving to Alberta, I'm coming in a couple of months. And I said, oh great, have you already got a clinic where you're going? She's like, yeah, Satori. And so I was super excited to hear that she was coming. But through her conversations with you all, she made that decision and she was very excited about it. So tell me a little bit about, um, you know, how you guys are bringing on physicians right now and what that recruitment, um, kind of program looks like for you all. What physicians know, um, if they're considering that new opportunity.

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Stephen: Yeah, I think the understanding where we're going and providing that kind of pathway for them to kind of understand, like I said, where we're going is huge. Obviously, all of the things that we're currently offering in terms of the support, especially for a physician coming from out of province or even out of country, to have to learn all of our you know, Alberta's billing codes and get familiar with that. That's a huge undertaking and something that you probably don't have time for. So to have our team there that kind of handles all that is just is so such a huge ad for a physician and you know, and they provide a lot of recommendations on which billing codes to use. Most physicians will seven or eight billing codes over and over, and there's thousands, and they just don't know that or don't have the time to really learn or look into that. So for us to provide that has been a huge, a huge add. Also, like I said, just the addition of the Collaborative Health Program and the add of that LPN to work alongside them is hugely beneficial for patients, for your support. They're looking after, again, all of that follow-up, all of that education is taken off your plate. And then with that comes that additional revenue stream that isn't seen in a typical clinic setting. So yeah, I think those are the main things. Again, we're trying to really provide a fun culture here and a lot of collaboration and a great network to be a part of and kind of further your career. You know, we have a lot of different subspecialties within our clinics right now. And if somebody had a particular interest, we would pair them with that subspecialty or do rotations at that clinic. So that's something that a lot of physicians are definitely interested in.

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Alitta:That's really interesting. And that actually is quite different of being able to, I think for a lot of physicians, the career progression sort of, it's pretty linear for a family doctor quite often, especially when you're busy practicing, it's really hard to say, I'm really interested in this area as well. Let me branch out there while I'm supporting an entire panel of patients. But that's actually quite different for them to be able to within the networkgo and work with other specialists and get that exposure and get that opportunity to learn and continue to grow and foster those new interests throughout your career. So I think that's definitely different and definitely something.

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Stephen: Yeah, yeah. And then, yeah, like we're always, again, looking for innovative ways to kind of change things and provide solutions. So a lot of that is within our software and providing really efficient workflows. And actually, the software that drives our collaborative health program right now will become its own EMR and we're doing a lot of AI research that will be implemented in that. And then, so the goal too, I guess, is to, and we have one currently, our Greenview Health Center, but we will have Satori Health Centers throughout the city and the province. And, you know, hopefully we go extra provincially. But those will be full service, state of the art health facilities that encompass primary care, specialty, allied health, you know, obviously pharmacy and everything. So, that's, yeah, that's where we're, that's where kind of we're headed. Definitely want to, yeah, get more involved in specialty care and, and while, while continuing to expand primary.

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Alitta: And you mentioned that kind of clinic, that clinics can come onto the platform or that you can acquire clinics. So I think it would be great to kind of look at, okay, from a clinic side, what can a doctor know or what can a clinic owner know that you guys offer? And then from the physicians or other healthcare practitioners, what are you recruiting for right now? So.

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Stephen: So obviously, we're always going to be recruiting in clinic physicians. Also, we're actively looking to expand and acquire clinics. But at the same time, we could, you know, if somebody's listening and they have a clinic or a panel that they would like enrolled in our collaborative health program, that's an option as well, where we would pair you with an LPN and they would work virtually with you to panel and manage your patients. And then with that, you know, obviously the physician will make a percentage of their billings, but the clinic itself will actually also make a percentage of those billings as well. We'd like to keep the clinic involved and motivated. So yeah, that's kind of the three ways people can be involved.

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Alitta: Amazing. What are the hopes for the rest of this year and for the next couple of years to come for Satori?

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Stephen: Large scale expansion, I would say, like, obviously, you know, we're going to do a lot of development on the software side and, and continue to, to evolve that. But yeah, we are, like I said, looking to build these health centers, looking to acquire just, you know, satellite offices or different clinics really want to get into some additional specialty areas.There's really no limit, nothing we're not trying to tackle. So it's exciting and yeah, we'll see what happens.

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Alitta: Well, I've chatted with, like I mentioned, a physician who was really excited about joining, but you guys just had a barbecue, you guys chat with the physicians all the time. Tell us a little bit about what are physicians saying about working at Satori and what is their kind of honest feedback about what it's like to be a part of that team.

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Stephen: Yeah, no, I think we have a great team. And I think part of that is just everyone has a similar mindset and everyone gets along quite well. So that's not a prerequisite to work with us, but it seems to be a theme. Yeah, no, everyone's just really like-minded. And I think that goes a long way. We do try to get together often. And so physicians really enjoy that. And yeah, just be part of like a community for a change. I think it's so competitive for physicians that to be a part of something where we're all kind of pushing in the same direction and focused on the same kind of goals and everything is a relief for a lot of our physicians.

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Alitta: I love that. And I don't think that's necessarily the case everywhere. I mean, when you're in a practice, either on your own or maybe one or two other people, and you're just running full tilt, it's hard to create that community sometimes. And the feedback that, you know, I've been in recruitment for a really, really long time within the healthcare industry, but others as well. And we know that the number one reason people leave is their managers or their team and that community that they're working with or lack thereof. And so, you know, that it's so critical. It's easier to get through things that are difficult when you have that team and the support and people that are in it with you and you're working together towards making things better versus kind of being in it on your own and trying to figure all these details out on a day-to-day basis from running the business to bringing in patients, to making sure you're delivering the best care at the same time and all that jazz.

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Stephen:Absolutely. And these aren't small, easy problems we're trying to solve or we're involved in. So yeah, having support and a true community and culture that supports you, it just goes such a long way.

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Alitta: I love that. What do you, I mean, you're talking to physicians and different folks all the time about joining the team. What are they typically asking? And what kind of questions do you get that you'd like to tell kind of a broader audience?

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Stephen:Yeah, yeah. Yeah, obviously, you know, different income levels and trying to kind of narrow that down. What does a typical physician make at the Tory? But then, you know, aside from that, it's really how much support can you provide me? And what does that look like? You know, how many hours or am I going to be expected to work to be able to maintain, you know, this lifestyle that I'm used to? And it's usually lessis the answer. So yeah, I think that those are the things.

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Alitta: Well, tell us a little bit about, I mean, we've got folks who are going to be watching this that are going to be interested to talk, but give us some of that, Cole's notes, or a little bit of a day in the life. What does that kind of look like for people? What could they expect if they were to join Satori and be a part of the team?

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Stephen:Yeah, no, it's so it's quite flexible. We're really trying to cater to the physician and to their preferences in terms of like, their appointment times and their weekly schedules. And, and so we're really not. We're not adding or we're not providing, you know, a firm structure or anything. It's really, really up to them. And then we just try to work around that. But yeah, like I said, just adding this collaborative health program will really reduce stress, reduce physicians, like I suppose, need to maybe fit in 50 patients a day or work that extra day or work that Saturday. They don't have to worry about that because they are being compensated through that additional revenue stream and able to keep that revenue up. So yeah, I think that helps. Obviously, there's no really additional work that comes with it. Like I said, your LPN, your health plan coordinator really manages that whole process for you. So you're really as involved as you wanna be in that collaborative health program.

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Alitta: Yeah.I love it. So it's more flexible. Because of the additional revenue streams, they can actually create a life.

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Stephen: Yes, hopefully. No, exactly. Yeah, no. And then in terms of like vacation, we're, yeah, we're super, super flexible and accommodating in terms of leave and vacation. We have a lot of support within our clinics where, you know, nurse practitioners or other physicians can see a doctor's patients while they're away. So that goes, goes a long way and really.

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Alitta: Vacation time? Is that what you just said? I think that's language that we rarely hear. I mean, in so many clinics, you have to get locum coverage to be able to take it, and it can be quite burdensome from a cost perspective and all that kind of, the shortage that exists. So I think that's also really, really interesting that because of the structure of the team, you're able to create opportunities for that vacation or that coverage and leave. People need in order to battle, burnout and have a life. They want to live. And I think post COVID, we've seen people bring back a little bit of emphasis on having a life. And so I think that's really great. Anything else that they typically ask that you want to be able to cover, you know, to the audience there now.

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Stephen: Yeah, no, I think that's the main thing. We offer some relocation support too for physicians out of province. Yeah, no, we're quite flexible, quite, you know, things are quite negotiable with us. So it's not, you know, one agreement for everybody. It's really, we try to personalize it to each doctor's needs and their priorities.

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Alitta: Well, I'll open it up again to anyone in the audience. If you have any questions about Satori and what a day in life might look like or anything at all, don't hesitate to pop it into the chat. You can put it in the chat feature there. Also, what are some of the best ways, I think there's a few and maybe Charen's one of them, but what are some of the best ways that physicians or others, because actually before I even get into that, tell us about the actual skill sets that you're hiring for right now. Like what are the top recruitment? I meannot even top, I'm sure you're recruiting for everything across the board. But tell us what those roles you're recruiting for today are.

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Stephen: Yeah, I would say family medicine physicians. Again, whether you have a subspecialty or not, you know, doesn't really matter. But in terms of our collaborative health program, any specialists, we're always looking for specialists to add to that panel or, you know, even doctors with this particular, you know, subspecialty or something that can provide a service within that. We just brought on a lactation consultant on our platform that will do some antenatal consultations for our pregnant patients. So, yeah, we're really looking to add as many services within that platform as possible. So yeah, anything, obviously, clinic owners who are just maybe tired of the management andthe business side of things, always looking to partner or acquire or do some sort of joint venture. There's all different types of ways that we can work together.

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Alitta:And then how about for the LPNs, NPs and that kind of jazz? Are you still hiring for more of those professionals as well?

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Stephen:Always, yeah, definitely. Always looking for nurse practitioners, LPNs, our health plan coordinators. Yeah, that's gonna be a forever hire for us. So yeah, always looking for them. And yeah, I don't know if there's, obviously it will be ways that you guys can contact me or look up our website.

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Alitta:Yeah, so I think, you know, it's always important to say that. So some of the best ways probably on your guys's website directly at Satori Health, they can connect and see the jobs that are currently available. I know on Cherry Health, there are currently physician jobs posted that they can engage with and check out and they can connect directly with you off of Cherry Health as well. When they look up Satori. Any other major ways or you guys had any conferences or anything coming up?

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Stephen We usually try to attend the Family Medicine Summit in Alberta. I'm not sure if we'll be making it out to the Montreal Forum. Yeah, we're going to hopefully be there. It's not confirmed yet, but yeah, no. Otherwise, just shoot me an email or a text and come by our office anytime. That's usually how we like to handle things. But yeah.

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Alitta: Good. Well, I think that's a great overview of Satori and why someone might want to consider joining the team. We're learning more about the team. I think from for our perspective, you know, working with you and getting to know what you guys are all about. It's been really fun to see your approach to it and what seems to be a really sustainable model as well for both the business and then for the practitioners that are involved too. Thank you for joining us today. Thank you everyone for attending and listening to us chat about Satori. And we look forward to, hopefully, if you're interested, engage either on Cherry or directly through the website to the Satori team. And we'll go from there. Thank you very much. Stephen, don't close your window. We'll stay on and chat a little bit further. But everyone else, thank you so much for joining today.

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Stephen: Thank you.