Separating Noise from Risk: How Healthcare Policy Dictates Platform Value

Ashley Kent (00:00): Hello, I am Ashley Kent, host of Growth DX. Today I am joined by Snigdha Udupi, who is the vice president on Capstone's healthcare team.

Ashley Kent (00:14): Where she works with private equity investors and healthcare companies on how policy impacts growth and ultimately investment decisions. extremely excited about this discussion today because this is something that I talk about almost daily with all of the organizations that we work with. And I think it's just incredibly interesting how working in healthcare specifically, policy can completely change the game in how you approach your growth strategy or whether it's your investment.

Ashley Kent (00:41): Strategy. I mean, you can have an incredibly attractive business one day, and then there's a reimbursement change, a new CMS rule, shift in Medicaid, and the economics completely shift underneath it. So, really excited to hear your perspective. as I know you live and breathe this every single day, and I think this will be an incredibly valuable discussion. So, welcome to Growth DX.

Snigdha Udupi (01:02): Thanks so much for having me, Ashley. It's an absolute pleasure and I'm

Snigdha Udupi (01:07): Just as excited to have this conversation. I think that it's very topical at the moment in in healthcare. but just to intro myself, I'm a vice president at Capstone and I cover provider services for primarily private equity and corporate clients. So I know provider services is a very broad topic, but I spend most of my time in government payer-exposed healthcare businesses and sectors such as

Snigdha Udupi (01:33): Behavioral health, women's health, home and community-based services and health systems. And my prior experience was actually working on the provider side and hospital administration and operations. So really excited to share perspectives from that provider angle and now as a healthcare policy analyst working with investors.

Ashley Kent (01:53): Amazing. You're gonna have a breadth of experience and perspectives to be able to share today. And so, you know, kind of diving off of something that I said before, and it's something that I've experienced with companies that we've worked with, you know, something that does make healthcare so unique is that it's completely contingent on what is happening within the market. and there can be, you know, an incredibly attractive company one day, and then something is passed, and it completely changes maybe how someone's approaching the business, an investment thesis, whatever that may look like. So I'm curious.

Ashley Kent (02:21): When you're looking at a healthcare company, how do you determine how exposed the underlying business model is to policy? And how are you advising partners as you're working through that?

Snigdha Udupi (02:32): I think maybe to start, one of the first things I would take a look at is payer mix. How much is self-pay commercial versus government payers like Medicare and Medicaid? That government exposure is really where my team spends most of our time because that's where a lot of the headline risk lives right now. And there's a lot of noise. there's new PE ownership bills that investors really care about. There are a lot of Medicaid headlines.

Snigdha Udupi (02:58): that are spooking investors before anyone's actually dug into the policy. So my job is to kind of get underneath the headline and and tell someone, does this actually touch your asset? And if so, how? And it's an ever-evolving landscape that we're seeing. So tracking some of those changes, whether it's on the federal side or on the state side, I think are are all top of mind right now.

Ashley Kent (03:21): That's incredibly interesting because I've worked with companies that, you know, they they're able to niche down in the way that they're saying they're working with, Medicaid exclusively, and Medicaid members, whatever it may be, or maybe if they're working directly with FQs and then something can completely change within that. I'm curious as you're advising, you know, your private equity clients, is that something that you're

Ashley Kent (03:41): advising them to stay away of just given the how niche it is and if they don't have that payer mix within there? or is there still viability into those models where they have a focus and a mission for certain populations? How do you kind of balance the two?

Snigdha Udupi (03:56): I mean, I think that there's certainly still opportunity, right? I think that something that is so Medicaid exposed might be a red flag for some, but I think there's importance in kind of getting to the underlying dynamics there. So something like reimbursement methodology varies more than people might initially think. So something that's fee-for-service exposed or value-based care exposed or even with bundled payments.

Snigdha Udupi (04:24): I think that'll all have an impact, and I think that other dynamics that are b beyond the the payer mix that are important to consider are things like the labor model within healthcare. I think that continues to be increasingly complex when you look at the different provider types with MDs, DOs, NPs, PAs, therapists, clinical, social workers. So a lot of the policies will depend on which types of providers can deliver

Snigdha Udupi (04:49): certain services and that varies by state. So I think a lot of different dynamics to unpack, especially as we talk about growth and and kind of scaling a business here.

Ashley Kent (04:59): curious if you've looked at businesses where you might look at them and you think you know this might look like a growth story but it's really a reimbursement story. have you seen any businesses like that where it's completely changed your perspective and how you started thinking about it and what it actually ended up being?

Snigdha Udupi (05:16): Yeah, absolutely. I think there are actually a few examples when surface level it looks like a growth story, but then I think unpacking it, there are a lot of reimbursement dynamics that are important at play. And you know, the underlying theme here is that when it's growth that's due to a concentration in a single code or site of care or a benefit category and not necessarily tied to factors like growing demand or a growing population that needs the care.

Snigdha Udupi (05:44): I think the one of the most interesting examples that I've taken a look at recently here is in the ABA space, and that's Applied Behavior Analysis. It's a type of therapy for children with autism, and the industry saw massive growth in the last five years or so. But I think it's always been a reimbursement story, in my opinion. It's it's a service that benefited from a favorable billing methodology, like the percentage of bill charges that providers could submit.

Snigdha Udupi (06:11): As opposed to a standardized fee schedule. So it's always really interesting to kind of dive deeper into the reimbursement aspect because it explains why we saw such a an explosive growth over the last several years. And I think you can also you you could pressure test a provider business by asking, if the reimbursement policy changed or or reverted tomorrow, would you still see that growth curve? I think that's

Snigdha Udupi (06:36): That's an important question to ask and if the answer is no, maybe you're not just underwriting the business, you're you're more so underwriting the reimbursement policy. But I think it is an important dynamic to uncover.

Ashley Kent (06:47): We can see such pops, but then also declines as that policy changes. We worked with a company that was, you know, working with VBC providers and they were chasing, the V28 policy changes and what was happening with risk adjustment. And that was something that they were hinging a lot of the product story and growth story around. But you know, at the end of the day, that's gonna continue to evolve. and that's gonna take away your growth thesis of, you know, it's not enough, to hinge your whole, company on. It's something that you can

Ashley Kent (07:15): leverage for sure, but can't be, what's driving your growth ultimately because it's going to change every single

Snigdha Udupi (07:21): Absolutely.

Ashley Kent (07:21): day. And how people adhere to that change and implement said change, completely varies as well. well we talked a a little bit about Medicaid. I think it's like the biggest, hairy topic that, you know, everyone

Snigdha Udupi (07:30): Yeah.

Ashley Kent (07:33): is talking about. Where is it going? but it's such a great example because policy change, it just doesn't affect,

Ashley Kent (07:39): Just reimbursement, it can affect eligibility, utilization, patient volume, staffing, and which ultimately affects just the total economics of an entire provider organization. So I'm curious when you're evaluating a Medicaid-heavy provider, what are you actually looking at given all of the various dynamics that are a part of it?

Snigdha Udupi (07:58): Yeah, it's a it's a great question. And I think when you talk about Medicaid, one thing that you hear in the industries, "if you know one state Medicaid program, you know one state Medicaid program." so

Ashley Kent (08:08): Mm-hmm.

Snigdha Udupi (08:09): there there's a lot of variabilities. So as a result of that, I think one of the first things that we look at is the geographic exposure. You know, is there significant exposure in a single state? How much do we really need to index to certain policies in those geographies? And this is really important because if there's risk

Snigdha Udupi (08:27): Of budgetary shortfalls in the state or a decision to cut reimbursement rates, the business could be fully exposed to that cut, versus if you're looking at something that has a little bit more geographic variability and diversification.

Snigdha Udupi (08:41): I think what's also important is exposure to managed care versus fee for service Medicaid. I know that the conversation around managed care and shifting more populations to that model has been a popular subject in many states for a number of years now. So, what does that shift look like and how will that impact certain populations? There are oftentimes that there are opportunities for provider led negotiations in managed care environments, whereas fee for service environments.

Snigdha Udupi (09:10): Maybe a little bit more rigid. So I think that's an important dynamic to kind of evaluate for a company. I'll also typically take a look at reimbursement rate history, how in you know any key geographies, how that rate history has trended over time, what does that look like over the last 10 years, and where can we expect, as a result of those trends, reimbursement to trend over the next five years?

Snigdha Udupi (09:35): And I think while that rate story and reimbursement, a lot of the conversations are surrounding that rate story, it it's important, but I also want to emphasize when doing diligence here, factors like coverage policies, network management dynamics, I think those are all also key in understanding the overall Medicaid story.

Ashley Kent (09:54): I think too for the provider organizations, like you said, you know, if you've met one state is not the same as the other. And so as, you know, I'm curious as you're advising provider organizations and they're looking to expand into different states that, you know, and they have a heavy Medicaid population, how do you advise those companies? Because it is going to be a very different environment from one state to the next. what what does that look like on the provider organization side?

Snigdha Udupi (10:18): Yeah. Well typically start, you know, at the federal level and think about what are some of the macro changes that are happening within CMS, within the administration, what changes are going to be having a downstream impact to states and then kind of going state by state to understand what are the specific policies that are

Snigdha Udupi (10:38): Geographic dependent because that's going to be the key underlying factor with any Medicaid exposed business. But I think a lot of concern right now within the Medicaid space and what we're talking to a lot of investors about is changes stemming from the One Big Beautiful Bill Act, or OBA, as we like to shorten it and say, changes that are top of mind for both business executives and healthcare investors. So a lot of that conversation is around work requirements.

Snigdha Udupi (11:06): Requirements

Snigdha Udupi (11:06): for expansion adults in Medicaid, some of the funding dynamics that will maybe trickle down to state specifics. So things like eligibility that are eligibility checks that are changing, and that eligibility used to be something that only had to be checked once a year. This is now changing to every six months. There's a concern that individuals may get administratively disenrolled if they don't meet that six-month eligibility check.

Snigdha Udupi (11:32): All these kind of macro Medicaid policies that are bundled up into this huge policy document, I think our role is to really understand: is this something that's going to trickle down to the specific asset that we're analyzing here and this specific state? So it really starts, I think, from the federal level, and then we look at what trickles down and then any state-specific impacts that are going to have a key role.

Ashley Kent (12:00): I love that because it allows you to have that macro view then down to the micro for what that would look like. I'm curious if you've almost have a cautionary tale though on the flip side of that, like this is great if someone is thinking this way and is being super proactive.

Ashley Kent (12:13): Have you seen organizations doing this level of, understanding and research that have gotten into a market and it was a huge mistake curious if you have any examples.

Ashley Kent (12:21): of the just downstream effects of what can happen if you don't do these steps ahead of time.

Snigdha Udupi (12:25): Yeah, and I and I think there's also concerns about reacting to policies really early. I think that, you know, maybe mid last year when OBA was still kind of a big question mark when we didn't know the impacts and it scared off a lot of investors from looking at Medicaid entirely. I think the conversations that we're having now, one year later, are entirely different. It's more so

Snigdha Udupi (12:51): Where can we still find opportunity amidst all these headlines and you know areas of risk that are being highlighted? Are there certain populations that are protected? And I think the answer is is yes. There's the pediatric population that's often protected, individuals with disabilities. I think that those are key areas that we can still take a look at as an opportunity within healthcare and an opportunity to

Snigdha Udupi (13:14): To help those individuals and not face as much risk from the business side either. So there's a value in understanding proposed policies and how they might play out, but also doing that risk analysis, looking at the bull bear base case and understanding what the probability weight of those scenarios are so that.

Snigdha Udupi (13:36): you don't jump too early or react too prematurely to a headline or a proposed policy.

Ashley Kent (13:42): I think that is such good advice because yeah, last year there was so much fear around Medicaid and you know, everyone's do we need to change our whole model? Do we need to think about everything differently? I was just speaking to a behavioral health platform and you know, they they service FQHs

Ashley Kent (13:56): primarily through telehealth. And we all know that, the policies around that have been just looming essentially, but not completely enacted upon. And so it's it's interesting as they're, working with future partners, like what is the risk of us partnering with you if this is your primary delivery method, given, where this could be potentially restricted down the road. But there's at this point everyone's kind of like, it's just looming. nothing is happening yet. And so it's kind of like, where do you find that balance of like being

Ashley Kent (14:23): Very proactive, but also recognizing that there's a lot of steps in between to actually get something to be passed all the way through.

Snigdha Udupi (14:30): Yeah. And it's really about separating the noise from what's actually at stake, right? And I think it's again, I would say just building out a range of outcomes. It's not just reacting to, one possibility. It's building out a range of things that could happen and what's the probability of of of each of those options. So I think for investors it's an important kind of decision to make.

Snigdha Udupi (14:54): compared to maybe walking away from a great company, you can price the risk into deal terms. So I I think those are some of the the more important considerations and and just not jumping ahead, I think, of of some of the risks that that we might see or prematurely kind of deciding.

Ashley Kent (15:12): 100%. So I'm curious to that end, are there certain signals that you're looking for that could move something from we need to, just be watching this to like we actually need to change our strategy and do something differently. What what is that tipping point when we need to pivot?

Snigdha Udupi (15:27): Yeah.

Snigdha Udupi (15:28): Really good question. And I I would say a few things that I think I would watch out for. One, if it's a policy that you're tracking, has this bill been introduced before? Because oftentimes it takes a few legislative sessions for a bill to pass. So if it's something that has been introduced on the floor for a third time, I think that's a signal that there's a push to pass the bill.

Snigdha Udupi (15:53): It's not just something that was, you know, introduced once and maybe it just fell off the priority list. I think the second point is to look at any guidance that's been released. That's often the precursor to actual policy change. So we'll track any guidance put out by CMS, any guidance put out by states, and kind of test what the reaction to that was before you know we see actual policy changes.

Snigdha Udupi (16:19): And I think another point, especially on the state level, to kind of distinguish between what's maybe noise versus actual risk, is looking at neighboring states or generally other states across the country that have been successful in passing similar legislation or similar policies. states often copy bill language. We we see this all the time when bills are proposed. so I think that's gonna be a key indicator of you know, is this something that

Snigdha Udupi (16:44): is likely to materialize or is this something that is gonna remain in the proposed stages?

Ashley Kent (16:49): going back over to the policy and you know how it actually becomes a growth strategy, there's companies they've built enormous businesses because they understood where reimbursement or policy, you know, was moving before everyone else did. When should an operator actually lean into policy as their growth strategy, or maybe even on the investment side, you know, as they're building their

Ashley Kent (17:14): thesis versus the other way around.

Snigdha Udupi (17:16): Yeah, that's a it's a really great question as the policy landscape is is always shifting. I think that's what makes it interesting for me to track. But as you kind of think about where you can lean into it as a growth lever, I think leaning into policies that have survived multiple administrations and are considered bipartisan are probably the most durable, right? So shifts to managed care, like we've discussed, or value-based care, I think are really good examples. These are ideas that have been building.

Snigdha Udupi (17:46): for years and years, they're likely to continue accelerating despite, you know, any sort of political changes or or political party changes and offer that durability where you can really lean into it and and kind of build a growth strategy around that.

Ashley Kent (18:03): From the investors lens, I'm curious too, you know, do you have companies that are building this on a durable change? Like it we've seen this over the years versus maybe a a temporary regulatory tailwind that's happening right now. How are they evaluating the opportunities that are in the market? And are there some that are a bit more opportunistic I've worked with a company and they were. It was exactly this as the beautiful bill was getting passed, and every six months reenrollment was happening and people were

Ashley Kent (18:29): falling off, there's a company that literally makes sure that people don't fall off and like their value all of a sudden skyrocketed.

Snigdha Udupi (18:33): Yeah.

Ashley Kent (18:35): They were acquired, and it happened

Snigdha Udupi (18:36): No.

Ashley Kent (18:36): really quickly because of policy. They've they've been around for years and years and it completely changed. So from the investor lens, how much are they, having this as a core thesis versus, something that like we gotta jump on this right now.

Snigdha Udupi (18:48): Yeah. And I think that example that you just showed is is a great one in in finding opportunity amidst a lot of uncertainty. I think when OBA was introduced everyone had questions and it was unclear, you know, what was gonna stick and and what wasn't. And I think this is a company that understood the policy change and and knew that some of the disenrollment risks were real risks and things that were going to stick around so they

Snigdha Udupi (19:12): created a huge value add in that market. So I I think the other thing is to really understand, the underlying policy dynamic and, in other words, like how difficult it would it be to reverse this policy? I think is probably the main question I would ask. If it's an idea that's baked into something like a waiver program, something that needs renewal over time, it may not survive that next renewal period. And that may be a real risk.

Snigdha Udupi (19:38): Something that's already codified in statute will require additional legislation to change it. And that's a much higher threshold for a policy change than something that hinges on a waiver renewal or administrative action. And I think the challenge with OBA and some of the disenrollment impact, the the challenge there and why I think this company maybe thought that it was a good time to jump in.

Snigdha Udupi (20:05): It OBA saves a lot of money and and there are there are significant cost savings that are outlined in the bill. That's hard to kind of move away from once you've already introduced some of those statutes. So it's it's challenging to to outline provisions, to kind of benchmark or estimate the cost savings, and then if you walk back the policy, you probably need to find the cost savings somewhere else. So it's a lot easier or it's a lot harder rather to

Snigdha Udupi (20:34): change that and to revisit it. So I I think when we think about durability, look at the underlying mechanism that even introduced the policy in the first place and how easy it would be to to reverse or change that.

Ashley Kent (20:48): Yep, no, I think that's such a great point. Well, I want to take you back to something you said at the very beginning there are certain, sectors that, don't carry the same amount of risk. You mentioned pediatrics, being one of those. I'm curious from the pediatric perspective, what what makes it particularly interesting or, risk resistant from a policy and reimbursement perspective?

Snigdha Udupi (21:08): Yeah, and it's an area I spend a lot of time in and an area I think I I really like analyzing. But to your point, the provider services landscape is very fragmented. There are often key questions that repeat across these sectors that we cover, things like coverage, utilization, reimbursement history and outlook, demand drivers. but the importance of these categories when doing diligence vary. And I think in in pediatrics it's a really great example of

Snigdha Udupi (21:37): Durable policies that we've been discussing. There's a federal mandate in place for states to cover services for Medicaid eligible individuals under 21. It's called EPSDT. That would take congressional intervention to change, which would be very difficult to do. So the rollback of that would be very challenging. And I think what's underrated about this protection that we see for children or individuals under 21 is that.

Snigdha Udupi (22:03): It's not just sort of a federal requirement for states to cover these services, but they have to ensure that there's adequate access to care. And a way of doing that is to ensure that reimbursement rates are high enough for providers and sufficient for providers to actually deliver those services. And that that's a pretty unique level of protection for this population. And I think what's also interesting is that it the pediatric space.

Snigdha Udupi (22:29): we see a high likelihood for for legal action if access to care is hindered. I think something about, you know, ensuring that children have access to the care that they need is is something that's been experiencing bipartisan support. It's not really a political issue and that there are very real policy impacts that

Snigdha Udupi (22:48): that would that you would see if if a business or or l a policy change at the state level or federal level could change, I think that the this population is particularly insulated amid any sort of political turmoil or policy changes that could come down the line.

Ashley Kent (23:05): that's confusing as well because you're gonna have within states you're getting auto assigned, you've lost, your provider who that is no longer in network, you're now getting assigned to a new provider. And it's interesting because, what happens in these, auto assignments, a a new provider group, and I actually work with a pediatric group, we just

Ashley Kent (23:24): literally yesterday ran a new campaign where they had over 1800 auto assignments that they've they've been sitting on because they just haven't had the bandwidth to be able to do any sort of proactive outreach. and we were running a baseline number to see you know how many just from the the letter that they received did they actually proactively go and schedule care with that. And there were, you know, 50 or so.

Ashley Kent (23:46): that did that within there and

Ashley Kent (23:49): I'm curious from your perspective too, what level of responsibility does the provider group have to ensure that the patients are getting in to receive that care? Because that that disconnect between the payer conversations and then also the provider who's going to be receiving them when maybe you don't have the infrastructure to do that. We just launched a campaign yesterday. We had immediately like, you know, 80 people reach out to book. and it just shows you how there's a big disconnect between the communications of the payer and the provider

Snigdha Udupi (24:14): Yeah.

Ashley Kent (24:14): and what responsibility kind of falls within each group to uphold those contracts.

Ashley Kent (24:19): Mm-hmm.

Snigdha Udupi (24:19): Yeah, and and I think that's a a responsibility that might come into play even more now as we've talked about these Medicaid changes and eligibility changes, because you're shifting from twelve month checks to six month checks. So you want to be in communication with those patients and you want to ensure that they're not accidentally disenrolled. So I think that layer of communication is going to be more important than ever. And of course it'll depend on the the payer mix of the business, but I think especially on

Snigdha Udupi (24:49): the the Medicaid side, it's more important than ever to kind of have that ability to communicate effectively and have a consistent stream of communication to ensure that there's no accidental disenrollment. And again, I think an opportunity for you know any sort of AI enabled or tech vendor to maybe assist with this because to your point a lot of providers may not have the capacity to to be doing that for every individual.

Snigdha Udupi (25:16): So I think this is also an area where a policy change will both on the the federal side and on the payer side can result in in an opportunity for a business to to build a platform that would help bridge that gap.

Ashley Kent (25:30): Yeah. No, it's been i incredibly interesting without, us there. They would have just, hoped that they would have shown up. and we see that, it's such a small percentage that actually, make that leap. even if they are giving away fifty dollar gift cards or whatever it is, you know, incentive that the payer is,

Ashley Kent (25:45): sending out there and you know, it was as simple as, we started leveraging text message for them to, be able to book immediately and, very different than receiving a letter in the mail. and exactly to that point, if you don't, move very quickly, six months could pass and that coverage could lapse. and you've, missed out on that opportunity to support that population,

Snigdha Udupi (26:01): I think

Snigdha Udupi (26:02): was the right reaction there. It's like, you know, you kind of have to meet people where they are. I think the text message is a is a great idea. I think historically we've seen the the letters go out and they get missed in the mail. People don't check their mail that frequently. so I I think it's a it's a great way to kind of step in and bridge that barrier and ensure that communication is is not lost. So I think that was the the right reaction.

Ashley Kent (26:26): Don't

Ashley Kent (26:26): we laugh? We're like healthcare, text, novel, idea. We're like

Snigdha Udupi (26:29): Yeah.

Ashley Kent (26:30): not paper to be able to reach people, but that's just the reality that we work in and just

Snigdha Udupi (26:32): Yeah. Yeah.

Ashley Kent (26:34): the everyday.

Ashley Kent (26:35): I'm curious if you're thinking of, you know, other practices and specialties. you say everyone is so different. If you were to pick, you know, another one that, has been gaining a lot of investor attention, whether it's women's health or personal care, dental, which one are you seeing as being one of the most attractive areas and particularly around policy and how that's been shaping that thesis?

Snigdha Udupi (26:55): Yeah.

Snigdha Udupi (26:56): Maybe maybe we can start with women's health. I think we we spend a lot of time in the fertility space within women's health and and the fertility market right now is I think entering an interesting period of of sustained growth and and structural expansion for really a few reasons. I think there's growing bipartisan support for IVF. There are broader coverage mandates that we're seeing across states and

Snigdha Udupi (27:23): And generally just increasing utilization and demand that's going to help drive that long-term growth. There are certainly some barriers, and it's more so on the pricing and reimbursement side, where you know it's primarily a cash pay business in a lot of situations, and pricing continues to be fairly opaque as a result. But I think as the market matures, we might see a little bit more of standardization and transparency there.

Snigdha Udupi (27:52): But it's been a really interesting one for us to look into because some of the more standard dynamics that we've talked about, like reimbursement and outlook there and Medicaid changes, it's not as prevalent in this space. But we look at it a little bit differently and more from a market or commercial perspective. So it's an interesting one that's definitely gained a lot of investor attention in the last couple of years.

Ashley Kent (28:15): I feel like I'm seeing it everywhere and maybe it's because I've like put it out in the world that this is what I'm interested

Snigdha Udupi (28:20): Yeah.

Ashley Kent (28:20): in. And so now I'm starting to see more and more. But it was a huge topic when we were actually where we met at the KAYO conference.

Snigdha Udupi (28:26): Yeah.

Ashley Kent (28:26): And obviously it's a, you room full of women at a healthcare private equity conference. So it's naturally gonna be a, you know, point of discussion. But I yeah, I'm curious too. There was a lot of discussion around,

Ashley Kent (28:36): those that are working in private equity firms and there's still kind of that just stigma of like, ooh, I don't really want to go there. You know, almost like people are like rebranding women's health to like be another name so it doesn't kind

Snigdha Udupi (28:47): Yeah.

Ashley Kent (28:47): of carry that connotation. But I I'm wondering if that tipping point is gonna be when there's policy change that is making just the economics incredibly, you know

Ashley Kent (28:57): attractive and it's gonna be something that people can actually start to change. So it's you know, getting that at the government level and then ultimately then the dollars are gonna start to follow within

Snigdha Udupi (29:06): Yeah.

Ashley Kent (29:06): there and it's not just mission oriented, but you know, at the end of the day, this unfortunately is how people function.

Snigdha Udupi (29:12): Yeah.

Ashley Kent (29:12): it's gonna follow the reimbursements.

Snigdha Udupi (29:15): Yeah.

Snigdha Udupi (29:15): And I think, you know, women's health is definitely something that's a little bit in earlier innings when we look at a lot of other provider services. But I I think where we've seen the most growth is really with in that fertility and and IVF space. I think that's something that especially with the current administration, we've seen a ton of support for IVF services and and and just general guidance, not necessarily real policy changes yet, but I think

Snigdha Udupi (29:43): That kind of bipartisan support we've seen over the years has been an interesting driver here.

Ashley Kent (29:51): I find this incredibly interesting because you know there's not many other industries that are out there that are so contingent on you know what is happening. You go into fintech, you go into, you know, other you know industries and it's just it's not something you have to keep your pulse on.

Ashley Kent (30:05): Your perspective is just incredibly valuable. but as we we wrap up the conversation, I have been asking everyone the same question. and it's been really interesting to see we've actually had the same answer to the last two people that have been on here. but I'm calling this our one fix. And so, you know, with this if you were to have one magic wand and you could fix one thing in healthcare tomorrow, no budget constraints, no regulatory constraints, no policy.

Ashley Kent (30:34): Politics, what are you fixing?

Snigdha Udupi (30:37): Yeah, it's a it's a great question. and I think a lot of different angles that that this could be approached from. But one thing that I think has been top of mind as we've been discussing the Medicaid space a lot are some of the the fraud, waste and abuse scrutiny that we're seeing right now in in the space. And I think the the market is treating the scrutiny as a reason to kind of avoid certain sectors within healthcare.

Snigdha Udupi (31:04): things like personal care or ABA that have been at the height of all of this scrutiny, but I think there's an important distinction to make between looking at, you know, if a service is actually fraudulent versus this service maybe has a few bad actors who've been exploiting something like a reimbursement structure. So if I had a magic wand, I think what I would address is is

Snigdha Udupi (31:28): The whole fraud, waste, and abuse conversation that I think, you know, it's an important conversation to have, but I think when we crack down on bad actors in a space like personal care or ABA, we don't want to unintentionally end up making it harder for populations like children or people with disabilities who genuinely depend on these services to get care. I think a lot of the time.

Snigdha Udupi (31:50): The crackdown response is is blunt and industry wide. And while the goal is to weed out bad actors in healthcare, I think my magic wand I I'd want to ensure that patients aren't impacted with their quality or access to care.

Ashley Kent (32:07): How do we insulate them from

Snigdha Udupi (32:09): Definitely.

Ashley Kent (32:10): the ripple effects of it all? Well, thank you so much for joining me today. I yeah, like I said, I feel like I could talk to you forever. You are a wealth of knowledge. and so just so glad to have you. and we will catch up in time.

Snigdha Udupi (32:21): Yeah, absolutely. This is a great

Snigdha Udupi (32:23): conversation and I think I think yeah, we could have gone on for for hours here within the the policy changes, but thanks so much for for having me and this was great discussion.