In the first episode of The PACE Playbook, Dr. Ankur Patel shares the personal and professional journey that led him to the Program of All-Inclusive Care for the Elderly. He reflects on studying pharmacy in India, becoming an accidental doctor, choosing family medicine and geriatrics, and discovering a model of care that addresses both medical needs and the realities of daily life.
Ankur also introduces Patel’s Three Ps: polypharmacy, POLST and goals of care, and preventive care. He explains how these principles help PACE teams reduce avoidable hospital visits, improve communication, and deliver care that treats every participant with the dignity we would want for our own family.
The PACE Playbook features practical conversations with the leaders and professionals shaping PACE. Presented by founding sponsor ChorusRx.
Why in healthcare we are treating patients not knowing the destination? And that is very important to ask. Nurture the place where you work. Get the negativity out of those places. And it's more even fun to work there. Anytime when you have to make a challenging decision in pace, think about that person and make the decision. Trust me, you will find your answer. Hello and basta everybody. I am Dr. Ankar Patel, a geriatrician, author of Age is Just a Number, and most importantly, a PACE fanatic. Welcome to the Pace Playbook, where we bring together people, ideas, strategy, and innovation shaping the future of Pace. I have been thinking about a time now that I want to create a podcast, I want to restart this podcast, and I couldn't be more happier to launch this podcast in September during the National Pace Month. I feel like Pace has given me so much throughout my career. And this podcast is a small way for me to pay back to PACE. Pace Playbook is proudly sponsored by our exclusive founding sponsors, Chorus RX. Backed by innovative science and technology, Chorus RX partnered with PACE Organization to improve patient outcomes, reduce medical costs, and streamline pharmacy workflow. I'm grateful to Chorus RX for supporting our mission to grow and advance pace across the country. For the very first episode, I was thinking, what should I do? Who should I invite? And then I thought about it. So I thought, let me tell my own story. So today, for my first episode, there's no guest. It's just you and me. And I'll like to share my own journey and just talk with you about myself. So where to start? This is not scripted. My friends, my friends call me CIA. Not because I am smart to be in intelligent agency, but because I was born in Canada, I grew up in India, and now I'm in America. That makes me Canadian Indian American. CIA. I have a long journey, like how I got into PACE, but actually I'm an accidental doctor. I was not even supposed to be a doctor, and I am. And the story goes like I grew up in India and I did my undergrad in India. So in India, we don't have an education system like America that we go to undergrad and then we go to medical school or pharmacy school. In India, we go directly after 12th grade to pharmacy school, medical school. So I went to pharmacy school and it's a British Commonwealth system. So there I did my undergrad in pharmacy. So I'm a pharmacist. And when I moved to US in 2003, April, and guess what? In 2003, January, the American Board of Pharmacy changed the rule that foreign pharmacy cannot just give the exams and practice as a pharmacist. They have to go to four years of pharma D school. So I applied to Lotto Pharmacy School when I moved to U.S. And I got accepted in Lotta Pharmacy School. But the fees were very expensive. And I thought about it like, if I'm doing four years of pharmacy school, mind well, and pay a high amount of fee, I thought, mind well, I should just become a doctor and go to medical school. So I applied for multiple medical school. And one of the medical schools that I applied to, and the dean asked me why you want to become a doctor. And I was very candid. I told them my own story that rather than putting myself in debt and becoming a pharmacist, I will pay the same amount of money and become a doctor so I can clear my debt faster. And the dean looks at me and he's like, nobody ever has given an answer like this to me, and you are it. So that's how I started my medical journey. But during that time, you know, how when things don't go according to the plan, you get upset, I was very upset about it. Okay, I wanted to be a pharmacist, and I have a lot of family members who were pharmacists. So the joke in the family was have to have Walgreens and CVS, we'll have Patel Pharmacy as a chain store. And that time, I was like, oh, why God is doing this to me? And a lot of time in life you learn that things happen for good reason. Fast forwarding my life right now, when I was the saddest in 2003, that why this happened to me, today, if you ask me, that's the best thing that happened to me. Because one door closed on me, and a beautiful second door that I didn't even thought of or dreamt of opened up for me. So that's how I got into medical school. Then I decided I wanted to do primary care. So I went on uh a family medicine track. I did my family medicine residency with the University of Alabama in Huntsville. A very good program. And then I was thinking to do sports medicine fellowship. I was doing this rotation in sports medicine, working with high school teams, and I thought it was so cool and fun, and I want to make my career as a sports medicine doctor. But on the other side, when you're a family medicine resident, you have your long-term care, post-acute care patient, your long-term care patient. So I was like, okay, I'm going to this nursing homes and seeing patients that was part of my rotation. And when I was going to those nursing homes in my inter year, some patients were very sick, some patients didn't even get out of bed. I started noticing that a lot of patients are on so many numbers of medications, and you don't need to be on all this medication. So that's time my subconsciously, my pharmacy knowledge started kicking in, and I started using my pharmacy knowledge and my family doctor mindset, combined it together, and started deprescribing medication. And we care for a patient during three years of residency, and a lot of the patients were more alert, talking, then I saw them. They were in the recreational area, playing games, getting involved with activities. And I was like, wow, like this is such a change or impact I was able to make on this patient. So every time I was driving home after my geriatric rotation or my nursing home days or post-acute days I used to do, I felt like satisfied. And that brought me joy. So at one point I was thinking, like, should I do sports medicine or geriatrics? And sports medicine was cool, and I was trying to convince myself, yeah, I want to do this. But actually, I got my satisfaction, joy in taking care of older adults. And maybe again, subconsciously, like my grandmother was always my influential person in my life. So I thought that I will be a better geriatrician than a sports medicine doctor. And at the end of the day, if this is bringing me joy, I should do it. That's how I ended up doing geriatric fellowship. So then I from Alabama, after I graduated my family medicine residency, I went to do my geriatric fellowship at Eastern Virginia Medical School in Norfolk, Virginia. Great program. I really feel like it is one of the hidden gem programs. You know how we always say PACE is like the best kept secret that shouldn't be a secret? I felt like EVMS in Norfolk, Virginia is a very similar program. It's a very well-run program. They have a great residency program in psychiatrists and in psychiatry, internal medicine, family medicine. But I did my geriatric fellowship there. It was such a wonderful experience. I did my one year off fellowship there. And then at that time, also my wife matched into a psychiatry residency there. So psychiatry residency is four years, my fellowship is one year. So after I graduated, my fellowship, I started looking for jobs in the area. And I interviewed multiple places. And my first job was at Riverside Medical Center in Newport News, Virginia. I was there as an ACE medical director, which is acute care for the elderly. It was a geriatric floor that we built from scratch and used geriatric principles within the hospital. So to me, it was more like pace but inpatient pace. You have a great IDT team. We focus on mobility, delirium, all those great things, but it stays within the hospital. So when I was interviewing for my medical directorship position at Riverside for the ACE unit, somebody told me if you're interested, there's also a PACE program there. And I'm like, oh, what is a PACE program? And in a simple language, one of the in-house hospital recruiters said, it is like an all-inclusive vacation, but for healthcare for seniors. And I was like, huh, that sounds very interesting. I would love to go check it out. So I went there. I actually sat in the IDT meeting. So Riverside Health System had a PACE program in Newport News, Virginia. I believe now, if I'm correct, I think it's an innovage PACE program and it's still in Newport News, Virginia. And I went there and I sat there, sat in the morning meeting, and I'm like, okay, this is cool. That means are you telling you have a social worker and a nurse and a PT and an OT, everybody in like one room discussing one patient. And I was like, wow, that's pretty awesome. But then I was always already made up my mind that I want to do inpatient geriatrics that time. That time I was more not ready for outpatient. I wanted the adrenaline, doing inpatient, taking care of the sick patient. And in ACE unit, a lot of people who don't know about ACE unit, what we focus on is all the geriatric principles like mobility. Do you know, like when patient goes to the hospital, our own participants, when they go to the hospital, they are in the hospital. They are laying in bed, not moving at all. So what happens when a participant don't move from bed? If they are sitting one day, let's say pneumonia, as an example, they go in for pneumonia, they are in bed, not moving for one day. Any guess that for not moving for one day in bed, what happens? And how many days of rehab you are thinking? Just guess, open guess. So one day laying in bed and not moving, you need two to three days of rehab. So does it make sense now when our patient goes for COPD and CO CHF exacerbation, is in the hospital for four to six days or five days, and then they have to go to post-acute care, and they are there for 10 to 15 days, and that's what it is. So what we did is rather than patient getting frail, not using their muscle, because muscle is something you use it or lose it, we made sure they use it. So on my ACE unit, the patient used to walk every day, two times a day. Aid will help them walk so their muscles remain intact. So a lot of them either can go home, or even if they go to a post-acute care for rehab, the length of stay in the rehab was a lot shorter. We focused on early discharge planning. So we will have an IDT team in the hospital that will work with me and the participants about discharging where it's appropriate discharge. We also focused on all the tethers that happens, like patient has foley catheter. Do they really need a foley or it was just put in into the ER and the Foley just stayed in? Or Ivy fluid at 125 CC an hour. Do they really need, if they're eating, drinking, okay, do they really need a fluid or I can discontinue? Because more tether, you tied up the patient with SCDs to prevent clots and IV fluids and oxygen and foley catheter, there are very less chances this patient will move from the bed. And our goal is to move out of bed. When tray comes for their lunch, breakfast, dinner, rather than putting the tray in front of the patient in the bed, we always encourage them to get up of the bed, get out of the bed, and sit in the chair and eat breakfast, lunch, and dinner. So that's the whole concept that we followed. And it was a great concept. We had great results. But one thing always bothered me there is when I was discharging a patient. Every time I discharge a patient, like I know that so-and-so patient, high chances will come back to the hospital. And the reason was never medical care. The reason always went to social determinants of health when I was discharging a patient. Miss Smith will come back, not because of I didn't treat the pneumonia or the CHF, right? But Miss Smith doesn't, once I discharge her, doesn't have anybody who will help her get the medication. If there is somebody there to get her the medication, then some other patient may not afford to pay the copay. As a doctor, it's very easy for us to write follow up with PCP in one week and cardiologists in 10 days after discharge. But realistically, how hard it is to get an appointment within seven days and 10 days to go see a doctor. And for our pace fund participants or more frail elderly, how they will even get there. So every time I used to discharge a patient, I kind of had the gut feeling that this patient will come back and it will be a readmission. And it was a readmission. And then I started connecting dots. I started connecting dots where I'm discharging a patient. But if this was a PACE participant, they don't need to worry about getting an appointment with PCP in seven days because they have somebody. In fact, they may even have a nurse who can go and see the patient at home before seeing the primary care doctor. Pays pay for the medications. Pays pays for transportation. And I was thinking like, oh my God, this is like a Disney world for a geriatrician where all my dreams can come true. Because every time I used to discharge a patient from the hospital, I'm like, I wish this patient had easy access to transportation. I wish this patient had easy access to go and see the primary care doctor. I wish this patient could afford the copay for the medication. Everything was I wish, but I can't do. My only control was when the patient was me in the hospital. But then I don't have any control when I discharge the patient. And that's where I thought this pace model of care is a Disney World for geriatricians where all your dream comes true. You have a social worker in the same room, you have a PT in the same room, OT in the same room, a nurse in the same room, transportation coordinator in the same room. You have all these IDT members surrounded by you with one goal is to help the participant. And I started seeing the value of PACE there when I was doing inpatient geriatric. Then, even if to a point I was, I had some relationship with the providers there at the PACE program. And I even said, if you have a participant that needs to be directly admitted to the hospital because of CHF, COPD, pneumonia, we can even bypass the ER. So me still not being in PACE, but indirectly involved in PACE way before I actually got into PACE. So I was working with the PACE program there in, and it was within the same health system. So it makes it easy. I was part of Riverside Medical Group doing inpatient geriatrics. PACE was part of Riverside Health System. So a lot of the electronic record was the same. And yeah, so if the provider calls me, Dr. Patel, we need a bed, need a direct admission, looks like a COPD exacerbation. We used to bypass the ER. Patient didn't have to wait in ER, directly will come to my floor, the bed will be ready. I will treat the patient, let's say four days, and then I call the PACE program back that I'll be discharging the patient. This is what needs to be done. And it was a warm handoff. And I don't remember, but we significantly decreased readmissions from that PACE program. It has been a long time ago. I'm talking about 2012 to 15. But that was very interesting. So a lot of time, if you don't know, by that time, my wife finished her psychiatry residency. And I don't know if you ever know a Jersey girl or married to a Jersey girl. You can't keep a Jersey girl out of Jersey for that long. So we decided to move back to Jersey. But on the other side, I also had family in Jersey. So the plan was to move back to Jersey. But I always joke with her, it's like when you marry a Jersey girl, you always have to come back to Jersey. So we started looking for a job in the New Jersey area in 2015. And then a recruiter I was talking to, he said, Hey, there's a good opportunity, Dr. Patel. There's a model called, I don't know if you know or not, but this model is called PACE. And I started laughing. And he's like, Do you know this model of care? And I'm like, Absolutely. What's what are they looking for? He said that they are looking for a medical director at a PACE program in South Jersey. And I was like, done. And that's how in 2016, January, I started my official journey into PACE as a medical director of a PACE program in South Jersey called InSpira Life, where that time we were around 160 or 70 participants. I started my PACE journey there. One day, it was my first week after orientation. I got an email that, oh, the CEO of the health system. So Inspira is a PACE program that falls within Inspira Health, which is a lot bigger health system in South Jersey, mostly serving three counties, and PACE falls under the health system. And the health system CEO emailed and be like, Dr. Patel, welcome to InSpira, and why don't we grab lunch? And I was like, young medical director, excited. I'm like, oh, the CEO wants to grab lunch with me. Let's go. So we had lunch and maybe we order our food. And he was talking, just asking me about my background. Food came and I didn't even take that first bite off the salad. And he's like, Dr. Patel, we might consider to close this PACE program. And I was like, What? He's like, Yeah, well, financially, we are not doing that good with the PACE program. So we might consider to shut down. And I'm like, but I moved from Virginia for this job. And he's like, Oh, yes, we need geriatricians. You can do population health. We have a lot of other opportunities within the health system. And I was like, no, no, no. Move because of PACE. I could have done that like any other place. And I'm like, when are you? If you want to, when are you planning to close it down? Do you close it down tomorrow? Or you have to just follow some process and have a few months? And he's like, no, no, no, it's not tomorrow, but we might take six months or so. And I'm like, I can turn this pace program around. That's the first thing that came out of my mouth. And he's like, can you do it? I'm like, yes. Here's how you will do it. And the first thought comes in my mind was, I have no idea. But I said, I played it pretty cool and be like, oh, I think I need more information. And that's something that if you don't know how to do it, just say I need more information and then figure it out how to do it. And he asked me, How much time do you need? And I had no idea even if I can do this or not. But I just said six months. He was considering to close the program down in six months. So I'm like, hey, six months. And he was like, okay, I give you six months and we'll see which track we are going on six months and we'll decide from there. And then he was nice. He also gave me an incentive that in six months, if we see the paces going in the right direction, I'll take you out for dinner. I'm like, okay, this is a great deal. So long story short, six months progressed. We did very good. We were in the right direction in six months. In one year, we stopped losing millions of dollars and we broke even. And after that, financially, we we were stable. So he took me out for dinner and parked in Philadelphia. So I think this is a good time to share my plays from my playbook. That what did I do there? That we were able to turn around the program. So my play was Patels 3P. So three Ps. What are those three Ps? So the first P is polypharmacy. And being a geriatrician, I'm a big believer is less is more. When I have residents, fellows, anybody rotating me, I always tell, or even my participants, I tell them medication is a culprit for everything until proven otherwise. A lot of things happen because of drug-drug interaction. Patients are on more medications than they should be. A lot of time prescription casket happens. So even when any patient, especially new patient, or they're coming for their six months or yearly assessment, my entire clinic stuff knew that if Dr. Patel is seeing the patient, we need to tell the patient to bring two bags of medication. And normally people get surprised, why two bags of medication, not one? And the two bag is for one bag is for all the medications that you are supposed to take, bring it in one bag. And the second bag was for all the medications that you were supposed to take, but you are not taking, or you have this old medications that is just sitting around in your house, bring it to the center as well. So we can clean the medication list, discard the unused medication, because when those medications are in patients' home, there are chances that they will take the medication. And the second back, we go through the entire med list. And with that med list, every medication needs to be attached to a diagnosis. And why I say this every medication needs to be attached to a diagnosis. Because a lot of time a medication was started for some reason and there was no stop date. So that medication, years later, it will just continue with the patient. And it's an extreme story. But when I was in Virginia, there was one patient was on cumidin'. Now, in that time in 2013, 14 times, all this new fancy drugs like Eloquis and it wasn't out there or it was coming, or Zoralto, it was coming, but it wasn't there. So cumidin was the drug that time they used to use. You monitor their INR. So I was seeing the patient and I asked the patient, Do you know why you take this medication? And she's like, Oh, I don't know. I've been taking it for years. I'm like, did anybody say that you have a clot in your lung or legs, or did you have irregular heartbeat? And she's like, no. And I'm like, then why are you taking this medication? So I called the daughter. And when I was calling the daughter, I'm like, do you know why? And she's like, no, I don't remember. I'm like, who started it? And then the daughter said, Oh, well, four years ago when mom had hip fracture, after the hip fracture, cumidin was started, and my jaw just dropped. Because that time when you start cumidin after hip fracture, it was more to prevent clots that can happen from the e mobility post-surgery. So it's supposed to be a temporary thing, not a permanent thing. So this patient was on this medication for four or five years later, which she shouldn't have been on this medication. And cumidin is a very dangerous medication when it comes to using it, not monitoring INRs. That is one of the examples. That it's an extreme example, but that happens. So you need to connect the medication with the diagnosis because of the prescription cascade can happen, right? So another example I can give is LASIK or fluorosamide, right? Why they're on this medication? Because a lot of time what happens is you are on a medication like mlodipin for your blood pressure. Mlodipin has a side effect of ankle swelling. And a lot of time, when we see ankle swelling, we start them on LASIKs. Versus we should actually take the culprit out, which is the mlodipin. It's the amylodipin side effect that is causing. There's not a treat another symptoms with another medication, which I see pretty often as well. Another one I always say is incontinency. Their medication for incontinency, is it true incontinency? Ask that. Is it because of the dementia medication? The side effect could be like urine urge or feels like incontinency. So rather than fixing the cause, we added another medication for incontinency. And incontinency medications have anticholinergic side effect. What that means is patient will have dry mouth and dry eyes and constant so what happens there now? You are adding more medication for constipation and others. So here is one challenge from the first P with polypharmacy, right? Focus on three medications PPIs, which is your omeprozol, pentoprozol, and look at that medication. Look at any incontinency medication, and look at fluoresamide, the water pill, and see in your PACE program, are this medication used appropriately, or there's an opportunity to discontinue that medication. Second P is post-form. And this is very near and dear to my heart. In New Jersey, we call it post-form, physician order for life-sustaining treatment. Other states might call something else. But basically, what this is talking about goals of care. And I always say is do you ever drive anywhere without knowing your destination? No. If you are leaving to go to work Monday morning, you know from work you are going from home, you're going to work. If you are coming back from work to home, you're coming home. So we do not drive anywhere without knowing the destination. Why in healthcare we are treating patients not knowing the destination? And that is very important to ask. What matters to the participants? They have all these chronic conditions, which honestly we cannot fix, but we can stabilize it. Have we asked what matters to them? And if they say, Doc, I, my granddaughter is getting married this summer and I want to attend my granddaughter's wedding, that's it. That's the goal. We need to write that down on the post forum, on our care plan, that the goal for this participant is to attend granddaughter's wedding. And that's how you will understand what's important to the patient, what matters to the patient. Even if the patient is non-compliant a lot of time, which our patients are, you can use this as an incentive that Ms. Smith, do you remember you want to go to your granddaughter's wedding this summer? If you do this, you might be able to make it to the wedding. And other things I always think about in health systems, and this is nationally, which actually other health systems and other health organizations should learn this from PACE is goals of care. And it's not discussed goals of care widely across outside PACE. In PACE, we are doing a better job, but it's not as much talked about outside. And that is one of the reasons why Medicare spends a lot of money in the last six months of patients' life. Because a lot of futile care happens at that time. So, long story short, why this P is important to me is when I started in 2016, January, I looked at how many postforms we have on our participants. And we only had 19% of all my 160, 70 participants I had, only 19% had postforms or goals of care forms. And that was a drive we did with the next six months with all the assessment. We'll discuss goals of care forms. It was me and one nurse practitioner, and a six month goal we achieved in three months. So in three months, brought in all the patients, cleaned up the med list, the first P, got everybody's post form in the first three months. And when anything happened to the participants, we took that post form and talked to the family, the participant. This is patient's wishes, especially with the family, because a lot of time family doesn't know. And they that's the time, especially during end of lifetime, family makes decisions from heart and not their mind because they're emotional. But these goals of care forms help the family to make decisions because that time when I'm talking to the family, it's not about me, it's not about a family member, it's about Miss Smith. What Miss Smith wants to do in this situation, and we share that with the family so they don't feel guilty or have that burden on their shoulder to make that decision of during the end of life. Fast forwarding it forward, I did a retro study on that. So when we had 19% in 2016, January. So I did a retro study of 2010 and 15. All my life participants that that died, 11%, two-thirds of the participant died in the hospital. Now, who wants to die in the hospital by choice? Nobody. Then why of a patient are dying in the hospital? And then I looked at the data of 2016, that two-thirds, 67% decreased to third, and 2017 and 18 decreased to 22%. That means all the life participants who died in 2016, sorry, 17 and 18, only 22% of those participants died in hospital, and other died at home or at a nursing facility because a lot of our life participants do not have family members who can care for them. So those are the changes when you do, you are doing the right thing, improving the right quality of care. You're decreasing the hospital mortality, but automatically doing the right thing, your cost of care goes down. And I'm a big believer, I'm a big believer that your cost of your quality of care is inversely proportional to cost of care. Spending more money does not always improve quality of care. But giving good quality of care will always decrease your cost of care in mid to long run. And then coming to the third P, which was preventative things. So what are you doing to prevent unnecessary ER visit, unnecessary hospital admission, which now a lot of PACE programs are doing it? They're trying to do more IV fluids in the clinic or at home, NMS, little thing. I will even call the fruits which are already on the ground, pick it up before it's rotten. That level is more PACE program has been doing. I have seen them doing it. I'm hearing that more and more PACE programs are coming up with an innovative approach, which is great things. We started doing IV fluids, enemas in the clinic, at home, wherever was appropriate to do it. And we prevented a lot of ER visit by doing that. Okay, so this was my three Ps. Wanted to share plays for my playbook. So I hope you learned something from this. I called it the Patel 3Ps, and the goal for this podcast is to share the plays and make our playbook that that is that helps the pace programs we can learn from each other. What did I do after that? So by 2020, I was doing all these great things. I was loving the model of care, established a lot of relationships in PACE. And at some point, you think grass is greener on the other side. So I wanted to try something new, and I just cannot stay in my comfort zone. So I wanted to start my own company, which I did. I wrote my book called Age is Just a Number, which by grace of God happened to be international bestseller multiple times, and all the proceeds from the book goes to a senior charity, such as food insecurity, senior loneliness, seniors bucket list. So it's little things. Whatever comes from the book goes directly to those senior charities. I did speaking engagement, I consulted for a lot of pace programs, vendors. We did turn around multiple pace programs who are financially not doing good. But then I realized that I was able to turn around pace programs, at least making them financially stable. But when you're doing the consultant role, a lot of time I felt like I can prevent a boat to sink and keep it floating, but I can't move the boat because I was not 100% invested in the program. So at that time, I got an opportunity again from the same PACE program where I started my PACE journey in Spira Life, and I went back as president of the Inspira Life program. So it felt like a full circle where I began my journey in 2016 as a PACE medical director, and I'm back as a president of the PACE program there. And during this time, I also realized coming back to I left PACE program as a medical director, thinking grass is greener on the other side. But during this journey, it was fun things. I was doing fun things, I did a lot of things. But also you realize that I miss pace and I miss to be inside a pace program, seeing the participants playing dominoes with them and cards with them and talking to them. And then I also realized that grass is not greener on the other side. Grass is greener where you water. Nurture the place where you work, get the negativity out of those places. And it's more even fun to work there. So this was my story. Just wanted to share my story with you all so you guys get to know me a little more, my background. One more play I would like to share with you that you can add it to your playbook is what my grandma told me one time when I was talking about how this model of care is, and sometimes you feel like you have to make challenging decisions because of a medication that might be expensive, or will this increase the utilization? And sometimes I feel like we overthink in a lot of things. Because I will share the play that my grandmother told me. She told me, Ancor, it is so simple. Anytime I have to make a decision, will I do this if it was my ba? If the answer is yes, I will do it. If the answer is no, I will not do it. Because if I won't do that for my ba, why I would do it for somebody else's grandmother. So from that day, I carry a mantra that I follow. I will care for my participants as I will care for my grandmother. And trust me, you'll find answers to a lot of the challenging situations. Keep a picture of your loved one. It could be your grandmother, it could be an aunt or whoever that you're close to who has influenced your life. And anytime when you have to make a challenging decision in pace, think about that person and make the decision. Trust me, you will find your answer. Okay, team, this is my story. Pace Playbook is proudly presented by our exclusive founding sponsor, Chorus Rx. Thank you to Chorus Rx for supporting our mission to grow and advance pace across the country. And to everyone listening, thank you for being part of the Pace Playbook. If you enjoyed today's episode, please follow and subscribe to the Pace Playbook on whichever platform you are listening on so you never miss a new episode. And if you found this conversation valuable, please take a moment to rate the podcast and share it with your colleague. It's one of the best ways you can help us grow the Pace community. Keep learning, keep sharing, keep innovating. And together, let's continue advancing the future of Pace. Until next time, Namaste.