Health Innovators
Health Innovators

Episode · 2 years ago

Dr. Grace Terrell On Implementing Commercialization Strategies & Tactics


When it comes to healthcare and innovation, the dysfunction of the system can seem hard to overcome without the right strategies. Why is it hard for some innovations to succeed? What are the key things you need to do in order to ensure your success? What are some of the biggest shifts in care delivery and benefits redesign?

On this episode, primary care physician and Envision Genomics CEO, Dr. Grace Terrell shares on her perspective on innovation as an early adopter of value-based care.

3 Things We Learned 

Innovators face a commercialization dilemma 

Many innovators find themselves at a crossroads as they try to commercialize. First, they can circumvent the current system and go direct-to-consumer, which means coming up with creative cash and subscription models, while handling the costs of educating the consumer market. On the other hand, they can go into the healthcare system, which means dealing with longer budget cycles and outdated payment models. This is a critical choice any healthcare innovator must make, and the decision affects every element of the business.

Why many innovations fail 

It’s tempting to focus on one part of the commercialization process - the product itself. Other key details must be considered; whether the product really meets the needs of the target market, how the product scales and who pays for it. 

The importance of being agile in innovation

Don’t become too fixated on one market segment or approach, be flexible enough to pivot when shifts are necessary. Many things in healthcare can change, especially in terms of policy and all healthcare innovators need to be in a position to move quickly. 


One of the biggest barriers to commercialization is how innovations are created. Healthcare innovators leave the industry to escape the dysfunction of the market, but end up creating products to sell back into that dysfunctional system. The problem is, it’s difficult to change healthcare outside of the system, or without involving many different people in the process. It takes a village to build a successful innovation and business, from investors, partners, willing payers and patients.



Welcome to Coiq and first of itskind video program about health innovators, earlier doctors and influencers and their stories aboutwriting the roller coaster of healthcare innovation. I'm your host, Dr Roxy,founder of Legacy DNA marketing group, and it's time to raise our COIQ.Welcome back to the show coiq listeners. On today's episode I have with meDr Grace Terrell. She is a primary care practitioner. She's also the presidentand CEO of envision Geno Mix. Welcome to the show. Thank you verymuch, happy to be here. So for our listeners who don't know whoyou are just yet, and just take a few minutes to let us knowa little bit about your background and what you do. Sure. So,as you mentioned, on the Premier Care Physician on the general intern is bytraining and still see patients in that venue. And back in the late to midS I founded with a group of other people in Organization Code cruisial healthcare. That was a multi specialty group that grew to about three hundred seventy fiveDOTS and C from North Caro on the that became one of the very firstorganizations. Now the what's now called the move to value movement. So wewere able to lower the cost of care, improve the Quala the some of thevery first medical home things. After that I found it as population healthmanagement company, coach Yes, which is now helping other organizations actually do somepretty innovative things within the here model redesign space, and for the last twoyears I've been the C envision genomics, which is a whole genome sequencing startupanalytics company focused on really changing the way we take care of people with wereand diagnosed, in this diagnosed diseases. So so what you're trying to sayis that you're really bored and you have nothing to do. Yeah, whatdid they do? A little bit of policy work in Washington as well withPJACK, whichcific position focus technically, but it's commission that looks at redesigning Faymentmodels for physition care. And so, yeah, I think life is anadventure and just need to make it something totally fun, which is yeah,yeah, absolutely. I think your story is so particularly interesting because of thedifferent Lens of healthcare innovation that I think that you've had the opportunity to puton, both being an early a doctor of Value Base Care also being anentrepreneur, being in nonprofit and for profit. So you know what it what advantagesand disadvantages do you think you have come into the innovation process as aphysician, being an insider into the healthcare ecosystem? So I guess an advantageI would have is that I practice regular, old control of medicine, you know, in a clinic, and have done so cross multiple venue since thosefirst out of training in one thousand nine hundred and ninety three. So I'vebeen in everything from a three person medical practice that included me and my motherin law and father in law, to a mostly speciality group to now alarge health system that's an immigrated health system. And within that context of seeing thegood, the bad and the ugly in the way healthcare is and hasbeen practiced, and have always been somebody who, I think, can say, well, you know, there are things that we can do from thisplace in space that can just be so much better. And so it's reallyfrom that land that I think I'm able to think through, you know,what's out there in terms of technologies and...

...other ass it's people and culture tosort of redesign the way we think about taking care of people. So sojust kind of paint a picture for us from your point of view. Whatis it like writing the roller coaster of healthcare in evasion? Well, I'mone of those people that sort of is tends to be on the bleeding edge. So what's one of the very first to be an electorrent health record backin the early two thousand were of the first to be what's patients in amedical home? So a lot of times when you're early and early adoptor orin the innovation space, there's a lot of uncertainty and when I look backnow I sort of smile because people occasionally one that teach me electroy about thingsthat I was actually, you know, in the early process of helping themto design and build about fifteen years ago. We didn't really know what we weredoing. Ended up we make a lot of mistakes. You have tobe willing to accept that and learn from them and in just continue to thinkabout the fact that there's a lot of ability, I think, from mostpeople in that are educated people to criticize, but the create, the creative process, which is so much more fun, is harder for people. We're justnot used to doing it. And so what I have found in mycareer that's been most helpful is to take all those criticisms and just keep makingthings and building things, and that's really what I think innovation is all about. Have have you seen us be able to move the needle? I thinkhe touched on something there's a lot of criticism about, you know, theold tradition, you know kind of the broken model, but at the sametime there's there's a lot of people out there that are doing really phenomenal things. So how have you seen the needle move? So I will go back, way back when I was a kid, will growing up in rum North Carolinaand watching my Grand Dad essentially have a terrible last couple of years ofhis life because of terrible cornery artery disease where, you know, he couldhardly get from the house to the Bourne without stopping to take a Nitro glystroomand bypass graft was something that had just happened for heart surgery, but hedidn't get it in time he died. To visit one of the first hardcases in the in the county, which was a friend of his who didget that shortly before he died and said something along the lines of they justcut it open like a chicken branch and but that was all better or something. Anyway, we went from that to the by the time I was inmedical school at Duke in the s bypass operations were being done at big healthcenters and we're, you know, this big fancy deal, but people weregetting better. And then by the time I, you know, was intraining as an internal medicine resident rake forest, it was stants that were out thereand you know, after that we got stabbens and bypass went to thecommunity hospitals and stints were going all over the place and fixing things. andMy my cousin, my dad, had a bypass operation in the s andthe Community Hospital was home in two days. He's and then if bet a cousinwho recently had cornary disease and he he was on in a day.Okay. So so if you take the long view, either like in colinaryartery disease, or you look at the you know what happened within the HIVspace, where when I was in med SICO, in one thousand nine hundredand eighty five, everything is dropping dad... become a chronic disease. Youdo see remarkable progress on the science side or the medical side. But whatwhat we haven't realized is that we're now doing the same thing on the Carolevery side, and so there's a lot of remarkable things out there. Ifyou were in the middle of having the bypass operation in nineteen one thousand ninehundred and eighty something, when it was still sort of early on, youwouldn't have imagined what it would be like twenty years later. So I therewere drugs that would reduce the incidents and cornary disease and much better care,but it was it was a process that was going on. That's what's happeningright now with carolivery, and it's because we're starting to think about things outsideof just the technologies that used to be in the big hospital buildings, butwhat can be done in the digital world. What can be done with, youknow, artificial intelligence? What can be done with genomics, with integrationof information across mutable sources? And when you take that and you model itwithin the context of care delivery and payment model, redesign, benefits redesign,then we are making progress. I think that what we'll see over the nexttwenty years would just be some significant improvement more than we can actually see whenwe're them the battles, when a day to dagnations. Yeah, yeah,absolutely. So I think it's really good for us just to pause periodically andkind of go down memory that lame like that in really kind of, Iguess I would say, celebrate some of the Innovation and progress that we've made, you know, not ignoring the fact that there's still a lot of progressthat needs to be made, but it can be discouraging and so we needto encourage ourselves that yes, we are doing it, we can do it. Can we do more? Yes, and we're all working to towards that. So a lot of the conversations that I have with innovators like yourself isjust you know, how difficult and complex it is to commercialize and innovation andhealthcare. So, from your perspective, why do you think that some healthcareinnovations succeed and some fail? Commercialization is all about the application of capital intoa system that will allow something to scale and meet people's needs. A lotof innovation people have a one off solution and APP if you will, thatthey're trying to superimprose on top of a very complex healthcare delivery system that doesn'tisn't able to sort of accommodate that within the payment delivering model. So Ithink the best way to think about any type of innovation is how does itmeet somebody's needs? How are you going to scale in and WHO's going topay for it? And so much of health care the person who's paying forit isn't necessarily the one who it meets their needs, and so a lotof people com up with solutions to fix a particular problem that we're not lookingat it within the complexity of of the system. Those that are successful eitherhave created a bypass around that, as you're now getting with the director consumermovement in ways, or they're working to to come up with a way ofintegrating into a system that actually makes it easier rather than harder, and that'snot always easy in the innovation space. Yeah, I think that's a crossroad. That is that innovators always face. Do I do I try to circumventthe current health care system? That is going to be a really longArdoris road for me. For me in...

...go direct to consumer and kind oflook at more creative pat cash models, subscription models, all of the differentinnovative business model options that we have today. But then there's there's all there's acost associated, a much larger cost with educating and promoting to the consumermarket. And then if you go into the health care system, it's howdo you navigate that right? How do you navigate that to make sure thatyou don't just get bogged down with something that's really innovative but because of thatpayment mechanism, that payment models that are still somewhat outdated? How do Inot just kind of find myself really right back where we are? Here's agood you know, if you're doing with health systems and you're sewing into ahealth system, they've got about an eighteen month budget cycle and so just theprocess of doing with large health care systems for what you need to do isa difficulty for many store ups have just lower amounts of cash and really can'tsustain that, particularly because most of the nature capitalists are looking at a prettyquick internal investment. So part about capital markets really just not set up forat yet. If you're if you're talking about the pay or market, you'rebasically trying to get someone to pay for your your thing. You innovated.They have a very different set of way of thinking about things that have todo with clinical utility and evidence. That's a little bit behind the way mostinnovators think about solutions, and so they describe that a little bit more.Okay, sure, so, within my space, holding on sequencing, weknow that if you do holding non sequence in on patients with rare and diagnosedmisdiagnosed diseases and a certain criteria, children with developmental delaying seizures that are anddetermined calls, people that have certain things that you just can't figure out.If you get that, if you get holding on sequencing, you can sometimessave hundreds of thousands of dollars down market with respect to the cost of care. But they tend to do their analysis at the level of being here's onemore fivezero tests, if you will, as apposed to seeing this five Thotest is going to say two other thousand dollars, and getting them to actuallysee that clinical utility is just a slow process. So that this part ofthat would be one example of that. Yep. So what phase of thecommercialization process are you at now? Do you have paying customers? Are youstill in kind of the pre launched? Help US understand that you're right atthe level where we've got a process with a product that is ready to goto market, which is code of comb which is a data analytic tool.They can make a diagnosis from the genetics information in about an hour for thingsthat used to take days Um, and so it requires certain license, inwhich we have, and we were this is just sort of the nature ofstartups. We were ready to launch last year, had capital lined up andthe the capital source was being led by someone who who died, and expectedlyat age sixty three, of unlikely event. So this is the type of thingthat happens in the start of world. We've still talked about the wild rideof entrepreneur shap right. I mean... just left for take that.I can't predict that went. It was a good friend and that wonderful mentorities. It's very hard for me to have a pretty party form for myself andthe real life there. He loves, his loves and is his family.You know, is very much suffered from that for war than I have.But but then thee list, that was just one of those things and that'sjust storing up. So Hey, you talk to me. You know,a year ago I would have said by this point we would have had expectationwe'd be about three, three million dollars in the positive respect revenue. Soin the started world, things happened. Those are black swarms and things likethat happened. So we are in the middle of right now of re designingthings around a emerger process with another company that has complimentary business model, andthat that happens, I think you're will be seeing some interesting things for thenext few months the year, so stay tuned. All right, that's great. So I think you kind of touched on this. You know, Iwas going to ask you, or I am asking you, what did someof the biggest challenges that you faced as an entrepreneur? Certainly having something likeyou just described happen is a huge challenge. You know, I like to havereally candid conversations about what it's like to be a healthcare entrepreneur because ifwe share those realities, I think it's just very encouraging, like hey,I'm not in this alone right man, it's happening to you too. Idon't take it so personal. And then if we share strategies of how weovercome that, you know, then together we can kind of move to needa little bit. So just kind of speak to maybe some of the otherchallenges that you faced and what have you put in you know ways that you'veovercome them? I'll give it. There was one outside my current company.But you talked about the research for capital. So my most especially medical group,players one very early own so that there was going to be a moveto value and they look with a strategy to to do that. It wouldrequire capital and partners as well as willing payers, and we went down thatpath and had some of the some results in terms of ruining the cost ofcare about twenty percent in a very vulnerable, high cost population of patients. That'sbeen published, by the way, in the general population health. Butthe players were slow in the politics changed what looked like was going to happen. After medicats pension legislation got sort of confounded by the Supreme Court decisions.It really changed the trajectory of the market. So we continue to have results,but we lad with respect to our ability to to to to move asfast as we thought the market was going to fast. So we ended upseeking out partners for what we were doing. Those partners included lab cool and waitfor his badness, which at the time was an independent academic medical centerin our community and ultimately we spent off the company called chess and that additionalcapital and the ability of that those resources has allowed chance to be successful.It's now managing, I believe, that a hundred thousand lives in value basedcontracts. Has Been Successful in multiple men care, advantage and next Gen,a CEO's. And when wait first just announced that it was going to goingto merge with ASTRIAN and Charlotte, were...

...just one of the largest health systemsin the southeast, in their press release they mentioned chance has been one ofthe resources and masses that they were bring into the table for what they wereplanning. So if you look back in two thousand and thirteen when we weremaking these very hard decisions about we're going to do this line, we don'thave money, who sort of be our partners? But where we are nowand the fact that you know, it's like that bypass story. We couldn'thave couldn't have seen me. We would be all right. It was avery, very hard road and the value that the shareholders of punstone will havethen, and she had over the next ten years should be multi phone relativeto the lunch, wit and tears and horn work get into it in thelate two thousand and ten to two thousand and thirteen. But it's taken longerthan we thought. It took partners. So what's what's that conversation like withthe board, with the shareholders, with the investors, of we're going,we're going to get there, but not yet. We're going to get therebut not yet. Sometimes it's a very hard conversation. You know, peopleare impatient, people were scared, they don't see the future and sometimes you'rewrong about the markets going on health fast it's going to go. But wethought all along that it was going to be about some very basic truths,which was there was a lot of exist expense and health care that could beimproved by redesigning models of care, that we're much more patient centric, thattook care to the age where there was a graded information and in positions thatwe're managing this with a team of people that could greatly benefit from integrated informationon everything from pharmacy to a Care Mon of redesign, and we were veryconvisit that was the case in the market was going to need that because ofall the trends that we're all aware of and to help your calls. Andso that was a truth that you know. We had some more reproof points thatended up being good evidence of that, and so is the rest of themarket came along with the way we were thinking about it. Then wecontinue to have all lose access and there's players now who will not do certaintypes of contracts in this in this way without our are being involved in ourmarket because they know that we know what we're doing. So that experiences madea difference. WHODO's right. Yeah, it's kind of whin. Yeah,so as you kind of went to market, you know, both in your previousexperience in your current experience, are you, you know, having anytype of like targeting or segmentation strategy where you're really separating the innovators, inthe early adopters and identifying and finding those in presenting your offering to them,versus presenting that to the mainstream market that's not ready yet? That deep adifferent absolutely. So we do the context of holding nome, sequencing and raredisease. One day, you and I and our children are granchildren. Weall have very unexperience of holding ome secreencing at some point in our lives tobe in a secure, safe, stored environment and it can be act says, by any type of physician or patient when it's needed to basically inform aboutmedical risk, possible disease, possible side effects from drugs. But that's notwhere we are right now. So where we are right now is that thistechnology is out there as getting cheaper and the people who need it the most, for those who are not very well...

...serve our current healthcare market, whichare those with, mostly children, with rare disease that are being this diagnosedand under diagnosed. So they end of the children's hospitals, the people thatwill benefit from this now or at children's hospitals, and so we the dialogis with those that understand is the children's hospital market. They know they don'thave the resources to do this. We're making it less expensive for them sothat they can order this testing and we're serving as a source of expertise sothat they can actually get it to the people that that need it the most. Ultimately, the whole system will have this as a technology, but rightnow there's a probably five percent of the population is just extremely poorly served byour current health care delivery system, which is focused on pronct diseases and thosewith rare diseases. Need a very different strategic approach show the places that theygo or the places that we need to be marketing and targeting. Right now, M so is, as we think about the commercialization process and all ofthe decisions that are made when you're developing that early adoption strategy, targeting,communication, branding, messaging, business model development, what are what are someof the strategies that you've deployed that would be valuable to share with our audience? So I think one strategy that you have to deploy, that we've done, is to not be everything everybody, but selling Adis there. You've gotlimited resources, limited capabilities, and so going towards those that move the mostand make it as easy as possible for them to provide that service. Sometimesyou have to choose not to have somebody to be a customer because it's goingto require too much resource and it's not really where you're waning in whip setof this. Sometimes you have to pivot. So you may think that you've gota product that's going to serve one segment and in that segment that inyour wall. When that happens, you have to you have to move andyou have to do it in a way that makes sense. So what exampleof this would be when we were developing chess, my population health management company, and two thousand twelve thirteen, this is before spring court decision in Medicaidexpansion. So we had developed the model for the dual eligibles, because wesolve them as being somebody that, moving forwardble care actors Medicaid expansion happened,would be high costs and that you could put some real inovation around giving thebetter care and it would be better for them and loward calls. When expansiondidn't happen, we just had to do something very different with that and reallywinning another directions, which Medicare expansion and Medicare showed sayings next Acos, notbecause we didn't want to serve that market, but because there was no way topay for it. If you look at some of the policies coming outin Washington right now, particularly with some of the focus on the waivers,there will that market will open up soon, but it wasn't there in two thousandand twelve just because of some policy changes yeah, yeah, absolutely.So I talked to some innovators who are either physicians that are first time turnentrepreneur or maybe an executive or a leader within a big healthcare organization that haveleft because they've ID identified a problem that they want to solve on their own. And one of the things that's really interesting is for the innovators that aredoing it for the first time, there seems to be a lot more youknow, naivete I'm going to do this...

...on my own, I've got allthe answers, I understand the problem, I understand the solution, I understandmy commercialization strategy and so forth, and whereas you know, other folks likeyourself who have like I've done this, I've done this. You know,there's lessons that you seem to take with you of like, we tried thisand it didn't work, or, you know, all of the different things. So what advice do you have for those listeners, those health innovators whoare, you know, may have the healthcare background, may not, butthey're they're doing this for the first time and they're really, really passionate aboutthe problems that they're solving and the technology that they're innovating what advice do youhave for them? Don't be arrogant, let's stay passionate and listen. Listen, listen to two people about what their real concerns are, because sometimes youhave a you're solving a problem that they don't think that they have. Andsometimes there is any reasons why doesn't were in that other people involved them.Most solutions are not one person's work, although that's sort of the way youwe tend to think about things in our code for our individualist culture, butis a focus, a team base. So many physicians, many entrepreneurs,may not have the types of business skills that are needed to basically manage alarger team, to basically understand everything from business development, marketing and sale.Some of them don't even know there's are three different things right right, justthat fundamental that those are three separate things. The founders are not always the bestones to to lead businesses to the next place in space and sometimes passioncan get in the way of execution. I am very fortunate that I've beenin a multiple different types of situations where I've been in medical practice, thatI'm see you for now twenty years that we grew from four or five peoplearound the table to organization and had, you know, two thousand Polis andhad lots of people helping me. But that's a very, very different placein space in terms of managing something of that size and complexity and building itand growing it than in the situation was a start up and chance the completethat was in between, which essentially had this spent off out of a bigcompany. We call this gunk works. Initially that became separate company. Sortof been between that. So I am not a on the dock right.So I have a lot of skills from because I've been these other things,but it's always within the context of realising that I'm a generalist and that thererequires a team of people, just like it does in the ore, justlike it as everywhere else, to basically build building, to build businesses andto something that can be important and meaningful. So a lot of folks that areat storing up me and they don't get that perspective because they've been frustratedwith the system that they find dysfunctioning than work. So then they leave tosolve a problem and they want to sell it back to that dysfunctional system.So have your hand around being part of something and understanding your placement Goo system. I think tenzero of those stories, if not a hundred thousand of thosestories, right, right. So you...

...touched on something, you know,evolving different people in the process. So I love what you just described becauseyou're talking about building business, business building right, right, and in thatit takes a village. Right, it all starts with the people. Evenwhen you're building a product, you know, we're evolving other stakeholders in that productdevelopment process. What are some of the strategies and tactics that you've deployedat possibly involved all vain patients and providers in the development of the solution oreven the development of the go to market strategy. So I won't give youan example right now in the place in space I am with glements, butI'll go back to what we were doing when we were building out some ofthe things that she has in I mean this this is the type of thingthat doesn't sound like an Inno nation. It that't sound like that, youknow, a kind of Hoodie or black total make or something in on stage. But we we were thinking about redesigning models of care around patients. Wedeveloped a committee of patients that we work from all walks of life that we'repart of our just like one of the other committees at commers that we hadfinance committee and operations and all these, we had a pension committee and theytold us what their actual experience was and they're very as opposed to, youknow, what we thought we were providing. Yeah, and from that we learneda lot and we understood what some of the difficulties were. One thingthat I'm doing right now that I am finding just so much fun as I'mworking doing some independent work for the primary care tell medicine provider, and I'mlearning so much from these patients that have zero access to primary care or desperateto find solutions for the problems that the technology can easily provide outside of thetraditional health care system. Sometimes don't know the limits of that, but I'mlearning more about the healthcare market and anyways that I didn't know then I hadin twenty years sitting in my practice or doing some of the things that wedo in our extensive this transitional care credit Corston see patients, because these arethe people that never came into my office and they're using a technology now.I've said about twenty five hundred patients food and ipand just like this since February. Sometimes they're in their car, sometimes they're at work, sometimes yeah home, sometimes they're in bed, sick their uplding, floating pictures of their boysand Ivy from me, a tillment poison ibby and it's it's even in space. I'm getting patient satisfaction data back. But these are patients that they callthem because there they can't get a refield the doctor's office or close or theycan't afford to going to see their doctor, but they can afford the copay forthis type of thing. So sometimes just getting outside of what you usuallydo and get another perspective, you know, I think can make a great dealof difference. It's just fascinating for someone that's been so entrenched and somany different facets that really can be that honest. Of I'm still learning,right, because we are, no matter what how much we know, we'realways learning something new. It was just so much done. I'm just sortof this is why I couldn't never specialize and quint essential generalists like I can'timagine just knowing one thing really, really well. I'm just going to doa lot of things not so well, but a lot of right, right, right. Yeah, so some of the challenges with like patient and providerCo creation, some of the conversations that I've had around this, especially fora startup, is that, you know, I completely buy into involving them inthe process. It's not something I'm opposed to. I'm eager to dothat. But when I reach out to...

...those folks, they're excited about whatI'm doing. They're just really not excited about contributing their time for free.And and then the innovators, you know, are straight for their bootstraft right,and in their strap for cash, and so, as they're making decisionsof what they're doing with the limited funds that they have, allocating funds topay those patients, sort of pay those providers for that feedback so they cancocreate with them, becomes a real challenge. How how have you address that?You know, where you just finding people that you had relationships with orpeople that were saying, you know, I'm willing to give you some ofmy time for free. What did that look like? In the Zoopho Igain for the patients a lot of terms. These were people that written complaints theywere passionate about a bad experience. If they had, yeah, invitedthem to solve that. So we may not be the typical people that hewas. Like I just had a really bad experience with organization and sort oflike great, when you become on verse of our Patient Committee and help usget better and see that that ended up because it was meeting a need thatthey had. It was an emotional need. They were unhappy people that wanted toresomething so true in within the context of of other types of audiences.Everybody's got MOMS and dad's and children and cousins twice removed, and you canreach out sometimes to friends and family, not just for capital, which isthe way a lot of people think about right right here, in terms ofproduct feedback. So you have to be you know, sometimes you're your familyis the only one who's going to tell you something negative and critical about you. So it can be that way for your friends and family. Let theminvest in your company, not was financially, but invest in your company with feedback. So that's just something that they go all innovators are to realize this, that the friends and family round is not just about money. And sosure the village it takes sometimes to build something absolutely well, Dr Turrell,I thank you so much for your time in these just incredible wisdom that youshared with our audience today. It's been such a delightful conversation. How canour audience, our listeners and viewers get a hold of you if they wantto talk more about what you're doing or have some questions with their own commercializationprocess? Sure so, you can reach me by email with gt rol atenvision genomenkscom. You can find me on twitter at grace to twenty two,and I'm on Linkedin. So I would be happy to have conversations with peoplewho we need those meetings and if it would be helpful, awesome. Thankyou so much for your time today. All right, what's the difference betweenlaunching and commercializing a healthcare in avation? Many people will launch a new product, few will commercialize it. To learn the difference between latch and commercialization andto watch past episodes of the show, head to our video show page atDr Roxycom. Thanks so much for watching and listening to the show. Youcan subscribe to the latest episodes on your favorite podcast APP like apple podcasts andspotify, or subscribe to the video episodes on our youtube channel. No matterthe platform, just search coiq with Dr Roxy. Until next time, LET'SRAISE OUR COIQ.

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