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How to Tame Your Wellness Dragons - Transcript

Hello and welcome to this webinar, sponsored by Extracon. I'm your host, Jesse Hercules, and I'm the President of Extracon. With me is Ted Dacko, the former CEO of HealthMedia. (Ted says Hi Jesse).

Okay, just a little housekeeping. First of all, all participants are in listen only mode so we're not all talking over one another. If you do have a question during the webinar just type it into the question box in your GoToMeeting panel. We'll be collecting those and answering as many as we can at the end. We have a pretty packed agenda, so if we don't get to all of them today we'll be following up with you directly. I did want to mention that we will be showing you some of our wellness portal today to show some ways to tame the 6 Dragons, but this is not really intended to be a full demo of the product. If you're interested in that just let us know and we'd be happy to arrange something for you.

We have a straight forward agenda today. We want to tell you a little bit about ourselves, and then go right into the 6 Wellness Dragons and explain what they are. Then we'd like to give you a high level overview of Extracon's portal as an example of how you can tame the 6 Dragons. Then we'll wrap up with some next steps.

Ted: So who is Extracon? Extracon is a cloud-based software company that builds and implements innovative, practical and incredibly powerful wellness portals for employers, wellness companies, benefit brokers and health plans.

The amazing thing is that our customers come in all shapes and sizes. Our customers include insurance organizations like Highmark Blue Cross. They include large employers like MARS, and Costco, and University of Phoenix. The include smaller organizations like Fremont County in Wyoming. They include wellness vendors like Spectrum Health, RepuCare and Allegeant. And they include Hospitals and healthcare organizations like Methodist, and Indiana University Health.

Ted: So when do organizations run into these Wellness Dragons? Jesse: They are all meeting these same dragons on the path to more effective wellness program. Let me tell you what that means. First, they are adding biometric screenings to the program. Biometrics are important for targeting interventions and measuring results. Second, they are trying to use more accurate data in their onsite and online programs. Whether it's data on physical activity, weight loss, flu shots, class attendance or anything else- they want the most accurate data they can get. Third, they are moving to integrated annual incentives rather than one-offs. So the incentives pull data from all over the program and become more complex. Fourth, many programs are using outcome-based incentives rather than participation-based incentives. Fifth, they need comprehensive reporting so they can show senior leadership that the program is working. But as you can see, there are 6 Dragons blocking the path on your journey.

Ted: So what are the 6 Dragons? Jesse: Let's find out.

Here they are: The first Dragon. Illegible or incomplete physician forms and faxes. If you're using biometrics in your program, you probably have a stack of these on your desk or in your fax machine. They are often illegible or incomplete. That's Dragon #1. The second Dragon. Monster Spreadsheets. More complex incentives, and more complex reports often means you create monster spreadsheets and formulas. That's Dragon #2. The third Dragon. If you're trying to run an effective program with more accurate data, pretty soon you find that your most important lifestyle programs have the least accurate data. Inaccurate steps & weight data is Dragon #3. The fourth Dragon. With a more comprehensive program, you'll find you have a whole lot of data files from other systems and vendors to clean up and integrate with your other data. That's Dragon #4. The fifth Dragon. You need to show your Head of HR and your CFO that your program is truly effective, and answer the tough questions they fire back at you. Fire-breathing questions are Dragon #5. The sixth Dragon. If you're using incentives based on outcomes and biometrics, they can be very effective. But there are very specific compliance requirements under HIPAA, the Affordable Care Act, and the Americans with Disabilities act. If you're not compliant, the incentives can bite you. That's Dragon #6. Let's meet these Dragons one by one and take a closer look.

Ted: So what's the problem with physician forms? Jesse: If you're using biometrics in your programs, you probably have a stack of these on your desk or in your FAX machine. If you have a small population or a lot of small worksites, this is probably the only way you can get biometrics. If you have a large population, it's likely there are people who would rather go to their own doctor than your onsite screening. We're working with a large hospital system that got over 2,000 physician forms this year - even though they also did onsite screenings. We're also in discussions with a health plan that got over 5,000 physician forms last year, because they're serving small employers where this is the only way to get biometrics. If 20% of them are incomplete and another 10% are illegible, how much bad data is going into your program? Most wellness leaders wind up typing in a lot of data that ultimately, they aren't happy with. It's almost impossible chase down every illegible data point and verify it with the doctor. If a data point is missing, it's not practical to send the patient back for another expensive doctor visit. There's isn't a good way to ensure complete and correct data. That's why this is one of our six dragons.

Ted: So what would a solution look like? Well, here's what a solution would need to do. It would need to know what tests are required - even if that changes based on age or gender, or based on the results of earlier tests. It would need to make sure the physician form is COMPLETE before the data is sent to the wellness program. It would need to make sure the data you get is 100% legible. It would need to link the patient to the data correctly. It would need to really identify the physician - with at least a signature and preferably something stronger. All of a sudden this doesn't sound like a paper form, does it? It almost sounds like a website or computer system. (CLICK) But you have to remember this too. Physicians will NOT sign into your wellness portal or website. And you can never pull data from all those separate physician EMR's across all the doctors in your network. Ted: So how in the world can you get quality data?

We've thought a lot about this at Extracon, and here's what we are moving clients toward. We think your wellness portal should come with an App that manages this process. So the App is replacing paper forms because it's smart and secure. What do we mean when we say it's smart? Well that means it knows what test are needed. Based on your company, based on the patient's gender and age, and even based on an initial visit for all biometrics compared to a followup visit that is targeting one biometric. So the patient logs into the app and shows the receptionist what tests are needed for that day. And the app can make sure that ALL of the biometrics are submitted so your data is complete. Pretty smart, huh? So here's what happens in the exam room. The patient is discussing their results with the doctor, and hands the phone to the doc. The physician enters the biometrics and signs the form using the touchscreen. The app can even take a picture of the doctor's face so we know who is really submitting the data. All of this means no paper, no fax. No retyping. No illegible scribbles. During development and testing we talked to a number of doctors about this, and not one said they would have a problem with this. Patients give them things to sign all the time, this is just more of the same. Ted: but what if the doctor has to ship the blood samples off to a lab. Then how do you get the data?

Jesse: in that case, the patient will get one of these lab reports in the mail a few days later. The good news is, smartphones now have high-resolution cameras built in. A good wellness portal app can use the camera on the smartphone to scan in the paper lab report. The App knows which data points are missing from the physician visit. It's usually cholesterol or A1C. Let me give you an example from a different industry. For more than a year, my bank has let me deposit checks by simply opening the online banking app on my phone, and taking a picture of the check to deposit it. If scanning in paper via cellphones is good enough for major banking institutions to use - when real dollars are at stake - it's good enough for your wellness program. Jesse: So Ted, I know you have a lot of experience moving companies from Excel and spreadsheets into better ways of managing their data. Tell us how that applies to employee wellness.

Having effective wellness at your organization means you're: *) running more programs & initiatives *) Keeping track of more data: attendance, participation, program completion, and more. *) tying all those programs and initiatives into your annual incentives. *) and reporting on participation and results to your leadership. So now you can see why this is a Dragon. To have an effective program, you need to manage and report on all this data, and you need it flow through to your incentives. But spreadsheets are not the way to manage the data.

And keeping spreadsheets on your computer or laptop isn't a great idea either. If you're managing everything in an Excel file, you may wind up with multiple inconsistent versions as you collaborate with others in your company or with vendors. You can't have everyone working with the same file at the same time. So you don't have one complete and up to date version of the truth. Those monster spreadsheets are on your computer. That means if your hard drive shatters - as you can see in the photo - your data could be gone forever. Very few of us do a good job of backing up our data in real time. And many of the ways people back up their computers aren't very secure. There's a another problem. Sometimes computers or thumbdrives are lost or stolen. Some of the biggest HIPAA fines ever levied happened because a laptop was stolen out of a parked vehicle or a thumbdrive was lost. Or someone used a rock to break a window and steal a computer out of an office. A stolen laptop is normally a $2,000 problem. Unless it has a bunch of HIPAA data on it, then it's a million dollar problem.

Ted: So Jesse, what would the solution look like? Jesse: The solution to Monster spreadsheets is to stop using a spreadsheet to do the work that an online wellness platform with a database is designed to do. If you can use the right tool for the job, you eliminate the problems of the monster spreadsheet. So what would an online wellness portal need to do, in order to replace your Monster Spreadsheets? First, the wellness portal needs to collect the data directly - so you're not the middleman with the spreadsheet. So if you're running an online Challenge, the participants put the data directly into the portal - from their computer, their smartphone, or a device like a FitBit. If you're running onsite classes and events, you need to take attendance directly into the portal using a phone or tablet. Anytime you catch yourself putting data into a spreadsheet, stop and ask if there's a way that data could go directly into the database instead. Second, to tame your monster spreadsheets, your portal needs to calculate the incentives. That means no more long formulas that pull from various parts of your spreadsheet. You define incentive rules on the portal, and then it knows who earned what, based on up to the minute data. Third, after it calculates the incentives, the portal needs to show participants exactly where they stand using a dashboard. Every participant needs to know what the requirements are, what they've done already, and what they have left to do in order to earn their incentive. Fourth, the portal needs to provide you with incentive reports showing who earned what. Fifth, the portal needs to back up your data and keep it safe. A database spreads data across different hard drives and servers, so that no one hardware failure can result in lost data. Last, the portal needs to keep your data secure - only letting the right people with the right permissions see and change the data.

So here's what the solution looks like. Both you and the participants connect to one online wellness portal. So there are many data sources, but just one consistent and up to date version of the truth, that lives in the cloud. What you see about a participants incentives and programs matches what they see. The data is backed up and spread across several hard drives and servers that sit in a heavily secured datacenter building. Each person in your organization has the right permissions to see data and do their job, and not to see anything they shouldn't. That's the opposite of a monster spreadsheet sitting on one person's computer. But that's what it takes to solve the problem.

Ted: So tell us about the third Dragon. Jesse: The third Dragon is Inaccurate steps and weight data. Let me explain why this is such a big problem. Lifestyle changes in physical activity and nutrition are probably the biggest opportunity we have to improve population health. Right? Population Health is not just about getting everyone a prescription for Lipitor and Metformin. It's about changing lifestyle, especially physical activity and weight. So are we doing a good job with this? No. Most wellness programs are just doing what they've always done. They run an 8 week program for walking or exercise. And later they run a 10 week program for weight loss. The programs are based on self-report data, which isn't really accurate. The incentives are minimal. Participation and results are not impressive. So BAD DATA leads to BAD PROGRAM DESIGN. If all we have is self-report data, we use these lightweight, short-term, simplistic programs.

And this is what it reminds me of. This poor guy is out there trying to put out a raging house fire with that tiny little garden hose. Sure, he's doing something. But it's not really going to make a difference. This is like having an 8-week program for physical activity when 70% of your population is sedentary. This is like having an 8 week program for weight loss when 2/3 of your people are overweight or obese. Self-report data leads to lightweight, short term programs. We have to do better.

Ted: So what does a solution look like? As I've said, we need good data for physical activity and weight. A solution would need to collect step data accurately and automatically. So the participant doesn't have to remember to write down their steps or log into a website. It has to be accurate and automatic. Second, the solution has to collect weights for you that are accurate and not just self-report. Believe me, you don't want to do 1,000 weigh-ins every year in your office. So there has to be a way that participants, by themselves, can put an accurate weight into the system. Third, if you want to effectively change physical activity and weight, they have to become a big part of your annual incentive programs. It can't be just a one-off, 8 week program. It has to be a key part of the big, annual, benefits linked incentives.

Ted: What you're proposing sounds expensive. Can companies really afford this? Jesse: When we talk about accurate data, most people picture the kind of expensive devices and kiosks that are being sold today. Sure, the devices and kiosks can collect accurate data (CLICK) But they're too expensive. These kinds of devices often cost $100 per employee for the pedometers and $5,000 each for the kiosks. And it's more than just the upfront cost. You'd have to consider the time and expense to get the devices to each employee, teach them how to use the device, and deal with questions and problems with connecting the devices to the portal and getting the data from the device up to the wellness program. These devices don't last forever - many only stand up to 6 months or so of daily use. And then you're dealing with broken devices and replacements. So if these much-hyped devices and kiosks are not the answer, what is?

Once again, we think the answer is to leverage the device that your employees already carry around with them. Starting in 2013, cellphone started to include the same kind of accelerometer sensors found in step-tracking devices. You may remember a few years ago, many people bought a portable GPS for their cars. Now, most of us use our phone as the GPS. A few years ago everyone carried around a digital camera. Now the phone is your camera. It's the same thing here. Right now a lot of people have a separate step-tracking device. But in a few years they will not. The phone will be your steptracker, just like the phone is your camera or your GPS. Since the phone is “ready”, what you need is a wellness portal App that moves that data automatically from the phone into the wellness portal. Your portal needs an app that makes it easy and basically foolproof. The phone will also be the way you get a validated weight measurement. How, you ask? Well, all your participants already have a bathroom scale. And the phone has two cameras - one facing down and one facing up. If your wellness portal includes a well-designed App, the app can take a picture to capture the person's weight and their face, at basically the same time. So you have a validated weight measurement. The App can do their food logging as well, taking a photo of the food on the plate.

Ted: so if bad data led to bad program designs, how does better data lead to better program designs? The solution isn't just getting accurate data, but making physical activity and weight a BIG part of your annual incentives. You need to supply year-round motivation, not just an 8 week program. There are many ways to get there, but here are two possible approaches, just to get you thinking. If you have a points and levels program, it could look like this. The bronze level means you completed the HRA and did your screening. The Silver level means you did everything at the Bronze level, and also earned enough points for participation in things like lunch & learns, online programs, coaching, etc. But the Gold Level means you are taking action on physical activity and weight. It means you are logging at least 500,000 steps per quarter. If you're overweight, you can also earn gold level by losing 5 lbs per quarter. Can you see how this works? HRA and screenings get you into the picture. Traditional participation programs move you up to silver. But the only way to reach gold status is to really put the time and effort into changing your lifestyle. On the other side of the coin, many of you are doing outcomes-based programs. How would you use accurate steps and weight data here? We think the way is to make physical activity or weight loss the alternatives for people who can't meet the 30 BMI standard. If your BMI is over 30, the way to earn the incentive is to make validated changes in lifestyle. It looks simple here on the screen. But this is how you get serious about physical activity and weight loss.

Ted: So tell us about the 4th Dragon. Jesse: Now let's meet our 4th Dragon. Lumbering data files. If you want to run a more effective wellness program, you will find out you need your wellness program to bring in data from all sorts of other places. You will have eligibility files from your HR systems. You will have screening files from your biometric screening vendor. You may have a file of everyone who's participated in or completed a vendor program such as smoking cessation or telephonic coaching. You may have a file of old data from last year, that needs to come into your new portal. You need to put all this data together on your platform, so you can connect the dots and run your incentives. But in many cases you'll find these data files have turned into a big problem. We hear the stories all the time. People say, I'm waiting on the vendor to load the data file into my platform. They say it will be a couple of weeks. Or, people tell us they had to pay one vendor to change the data file format so the file could go into the other vendor's system. Or they have to completely reformat a file each week, manually changing it so it will import into their system. Ted: So what would a solution look like?

Here's what a solution needs to do. A good portal can let you map and import your own files, so you're never waiting for a vendor or re-arranging files or having to re-arrange in Excel. A good portal can remember the mapping, so weekly updates of things like eligibility files can be a breeze. A good portal lets you create and run reports in real-time - your data, when you need it. Ready for export. Finally, a well-designed portal can also eliminate the need for many of the files you load today.

What do we mean by reducing the number of data files? Here are some examples. A good portal will let you do the screening directly into the portal. So your screeners can put the biometric data directly into the portal on a tablet, at the time of the screening. No files to load, no mismatched data, and you're not paying for a screening for anyone who isn't eligible for one. A good portal will do your screening scheduling and reminders as well, so that's one less vendor and data file also. A good portal will let you do check-ins for onsite programs and events directly into the portal. No more sign-in sheets, no files to load. A good portal will have a Single Sign-On option. That means you won't have to load eligibility files into the wellness portal, ever again. Wouldn't that be a relief? And a good portal will let your coaches do their work directly through the portal - no file of coaching calls or completions to load. These are just some examples - the important thing is that whenever you're loading a data file, stop to ask if there's some way to do that task directly in your portal so the data file isn't needed.

Ted: So what's the fifth Dragon? Jesse: When you're trying to build an effective wellness program, you need the enthusiastic support of your leadership. That means you have to present reports on your results, not just your participation. And that means you have to answer the tough questions. For example, do your wellness program participants improve biometrics year over year? In other words, if someone does your diabetes education program, in Year 1, does their A1C improve in Year 2? If someone with multiple health risks does your coaching program, are their biometrics improved at the next screening? Here's another one. We hear all the time from executives who think that the company fitness center is only used by the people who already exercise. Or the health incentive program is just giving money to people who are already living a healthy lifestyle. In other words, they think all the wrong people are joining programs and earning incentives. So can you show that the right people - the ones who need help - are joining your programs? Here's another one. Imagine you've worked hard and this year's Health Risk Assessment shows lower risks than last year. Sounds great, right? But can you show that really translates into lower claims costs? Tough questions, right?

There's a reason most wellness programs can't answer these questions. It's because their data is in separate places and you can't connect the dots. The HRA is in one place, onsite programs are in another, online programs are on some other system, and incentive data is somewhere else. Why do most wellness programs have their data separated like this? It's usually because they added these different initiatives at different times and use different vendors. So they have this free HRA from the carrier, but it doesn't connect to anything. They have a vendor for online Challenges, but that doesn't connect to anything. And often the onsite programs and incentives are still being run on a monster spreadsheet. If your data looks like this, you can't answer the fire-breathing questions. And that makes it hard to get the support YOU NEED from your senior leadership.

If you want to answer these kinds of questions, you need to put your data in one place. You need a portal that actually connects the dots. So you can follow participants from the year 1 screening and HRA, see which people did each program, and which people did NOT participate, and then see what happens to their HRA and Biometrics in year two. This is the opposite of a silo approach. Now the data connects, because it's all in one place. This is the kind of data connection you need to answer those tough questions. Are the right people joining your programs? No problem, you can see who joined Program 1 and look to see what their health risks were in Year 1. Do the programs improve outcomes a year later? No problem, you can connect from Program 1 to the HRA and screening data in Year 2. Jesse: Ted, are you seeing any potential problems here? Ted: Yes. Many employers have policies in place that HR can't see employees personal health information. Does that make it impossible to connect the dots? Jesse: That's actually very common. In that case you will need a program evaluation consultant or wellness vendor to do this analysis for you. There are a lot of vendors what are happy to do this kind of work, BUT ONLY IF the data connects together. So even in that case, you need a database that links all this data for the outside vendor to analyze.

Let's talk about that last fire-breathing question. If HRA results improve, will that really drive down claims cost? There are two ways to answer that question. The first way is to look at your own company's claims data and do a carefully planned, very expensive study. That's the hard way. That could cost you 5 years and a million dollars or more. The easy way is to use a Health Assessment where that careful and expensive study has already been done for you and the HRA is already validated against claims data. So our advice is - pick your HRA very carefully and only use one that's validated against the gold standard of claims data.

Ted: So what's the final Dragon? What are these incentives that bite back? Jesse: Since the Affordable Care Act, employers have the chance to use some very powerful, effective incentive strategies based on outcomes. So instead of a $25 giftcard for participating in a walking program, now employers might change your health plan premium by $100 a month based on things like blood pressure, cholesterol, blood sugar and BMI. In other words, employees who live a healthy lifestyle - or at least work with their doctor and take their medications - can pay a lot less. Employees who don't like a healthy lifestyle and don't take their medications wind up paying a lot more. This can be a lot more effective than paying for participation. With outcome incentives, you are paying for the outcomes you want. But here's where they bite back. If you're using these kinds of incentives, your process has to be compliant with Hipaa, with the Affordable Care Act, with the Americans with Disabilities Act, and other laws. As an example, the ACA says you have to make alternative standards available for employees who don't meet the regular standards, and in some cases you have to work with the employee's personal physician to ensure there's an alternative standard just for that employee. If your process is not compliant with these laws, then the incentives can really bite you.

Ted: So how can wellness programs stay compliant? Jesse: Well, the best way to stay in compliance is to follow the Affordable Care Act. So a solution would incorporate the ACA incentives and alternatives process right into the portal design and workflow. It would be designed around the ACA steps and categories. It would let you set up a variety of alternative standards. So if someone doesn't meet the regular standard, there is another way to earn the incentive. For example if someone has a biometric screening and their blood pressure is too high. They don't meet the regular standard. Now you need to have one or more alternative ways for them to work on the problem and earn their incentive. A solution would need to have a process for physician waivers. So there needs to be a way for the participant to request a physician designated alternative or waiver, and submit documentation to back up that request. And you would be wise to keep a record of all requests that come in, any and all correspondence back and forth, and your final incentive determination for that participation. Again, the system should do that for you and make you follow the ACA process. Finally, a solution should have clear dashboards and action items for participants. At any time during the year, they should be able to see where they are in the process, what they need to do next, and what incentives they have earned. CLICK There are a couple of bonus items here as well. Bonus: Alternative Standards based on Improvement (not participation) Bonus: Bring in validated lifestyle data for steps and weight.

Ted: So can we see some examples? Jesse:

We don't have time for a full demo today, and there's a lot we simply won't have time to show you. But we can go through some examples to show how a well-designed portal can help you tame the 6 Dragons. Flow: Sign in as SampleSite6: *) Now, we don't have a way to show you an app screen via GoToMeeting, so unfortunately we won't be able to demo the apps for physician forms, steps and weight. *) But we can show you a lot about defeating the Monster Spreadsheets and Lumbering Data files. Let's go there first. To defeat the Monster Spreadsheets, you'll want to run your online programs through the same portal that does your HRA, Biometrics and Incentives. Your data ties together on the portal, not in Excel. So here you can see that your HRA data is in here (click HRA), and your screeners can put the data directly into the portal at the screening. (click Screen this User). Then you want to run your Individual Tracking programs on the portal - you can see Shawna is in a Sleep program. As well as your Team Challenge programs - you can see this Steps challenge with participants and teams from across the organization, competing and being social. Then you want to take attendance at your Lunch & Learns and other programs through the portal (click Attendance). And you want your Coaches and participants to use the portal to document the coaching process. If you do need to bring in data from elsewhere, your should be able to map your data files so that any format will work. Click upload users' progress and show mapping. So you can see here mapping an outside data file and bringing it in. If you're using the portal to run all of these kinds of programs, then you don't need a monster spreadsheet to calculate your incentives. Instead, (click Incentive page), participants can see all the ways to earn incentives, and how they are doing - right on their dashboard. And you can run incentive reports that give you data in real-time, based on your unique incentive and points setup. That's how you defeat the lumbering data files and monster spreadsheets. It also gives you the right tools to answer those fire-breathing Questions. Show HMRC T1/T2 report. When all the data is in one place, you can compare program data across different years and show improvements to your senior leadership. Now, let me log into a different account and show you what to do with those incentives that bite back. So you can see here a set of 4 outcome based incentives. What I want to show is that the portal incorporates an ACA-compliant design. It shows participants what the standards are, whether they met the regular standard, and then what alternatives are available. So in this case the person met the blood pressure and glucose standards, but did not meet the BMI or Cholesterol Standards. And I want to showcase what we think is the best approach for incentives. Because they had high cholesterol, they need to go to their primary care physician. So they go to their doctor, who generally prescribes a medication and schedules a followup visit to see if the medication is working as expected. So on the followup visit, when the medication has started working, the portal App lets the doctor put in the new cholesterol reading. If the medication is working - and cholesterol is improved - then the participant earns the incentive. So that's the right way to approach blood pressure, blood glucose and cholesterol. If they fail the screening, they are going to have at least two visits with primary care - one to get a prescription and a second visit to see that the prescription is working. The best practice is to pay the incentive based on the improved biometrics at that second followup visit. You can also see the portal allows the participant to request a physician-designated alternative or physician waiver. There's a link where the participant makes the request and uploads any documentation. The portal keeps track of all communication back and forth during the appeals process, which will be a big help to your in ACA compliance. Finally, have a look at the BMI standard. The participant has a high BMI, so they did not pass the screening. But you can see two alternative standards - either walking 500,000 steps as validated by the App, or losing 5 lbs also as validated by the app. As we said before, we think validated lifestyle changes are the best way to improve BMI. And you can see how it works right here.

Ted: That was very helpful. Can you summarize what we've learned today? Jesse: Sure.

Wellness leaders want more effective programs based on validated data and well-designed incentives. But their path is blocked by manual data-handling and spreadsheet work, and data that's inaccurate or doesn't connect together. A well-designed portal with integrated Apps can tame the “Dragons” and let you have the effective program you want. Don't design your program around the limitations of spreadsheets and self-report - design a better program and find technology partners to make it possible.

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