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Pandemic Prompts Renewed Focus on Mental Health: What’s Your Plan?

Posted By Louise Probst, Wednesday, July 1, 2020
Updated: Tuesday, June 30, 2020

Employers increasingly see a need to address the emotional fallout of the coronavirus crisis, even as they focus on protecting their employees’ physical health. Improving resilience and emotional well-being is critical during these challenging times, which is why workplace mental health will be the spotlight of the 2020 BHC Summer Forum on July 29.

 

There is mounting evidence that Americans are experiencing COVID-19 as a serious threat to their mental health. A study by Express Scripts found that the use of prescription drugs to treat anxiety, depression, and insomnia spiked between mid-February and mid-March of this year, with prescriptions for anti-anxiety medications alone rising 34%. Of the prescriptions issued during this period, more than three-quarters were new prescriptions. Just months into the pandemic, more than a third of households contacted by the Census Bureau reported symptoms of clinical anxiety or depression.

 

It’s clear that the pandemic is exacting a tremendous psychological toll, which can severely impact employee focus and retention. Many Americans worry that they or a loved one will get infected. Juggling work and childcare, fear of job loss, and loneliness are other common sources of stress. Experts say people with pre-existing mental health or substance use disorders are at increased risk.

 

Workplaces have diligently implemented new routines to prevent the spread of infection, with checklists that include social distancing, temperature checks, and a doubling down on disinfectant. Yet there is a gap in guidelines for navigating the pandemic’s psychological effects.

 

In fact, the COVID-19 crisis has exposed the cracks in our already fragile mental health system. Unfortunately, the workplace is often the last place where mental health is discussed. According to the National Alliance on Mental Illness (NAMI), roughly 85% of employees' mental health conditions were undiagnosed or untreated before the virus struck. This despite estimates that mental health conditions cost employers more than $100 billion and 217 million lost workdays each year.  

 

Fortunately, there are many resources available for employers who want to step up and effectively support their employees, and the BHC’s 2020 Summer Forum is a great place to start. Join over 300 benefit and wellness leaders to learn about best practices for increasing awareness, decreasing stigma, and creating a culture of health. Featured speakers will include Dr. Charles Zorumski, Head of the Department of Psychiatry at the Washington University School of Medicine, and Mettie Spiess, CEO and Founder of A World Without Suicide. To learn more and to register for the virtual conference, please click here.

 

Warm regards,

 

Louise Y. Probst

BHC Executive Director

 

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A Role for Government: Investing in Better Value Health Care

Posted By Louise Probst, Wednesday, June 3, 2020
Updated: Wednesday, June 3, 2020

Unimaginable only a few months ago, health care organizations have experienced a radical reversal of fortune. Like many things upended by COVID-19, so is the long-held belief that the health care industry is recession proof – clearly, it is not. Health care organizations, like most businesses today, find themselves dependent on lifelines from the federal government, laying off health care workers and dramatically cutting spending.  

 

Considerable recent attention has focused on the federal grants to health systems across the nation to offset COVID-related losses. The conversations highlight the disparities among hospitals in terms of the populations they serve, their reserve balances, and ownership. The May 25th New York Times article, Wealthiest Hospitals Got Billions in Bailout for Struggling Health Providers, offers a detailed look into issues of equity across “have” and “have not” institutions.  

 

For me, the article underscores two things: (1) the political difficulties inherent in attempting to distribute money quickly, equitably, and thoughtfully, and (2) how very large and resource-rich some of our non-profit health systems have become. Multiple billions of dollars in reserves might only translate to months of operating income for many health systems.  

 

Missing from the conversation, and of critical importance, is how the federal government can use these lifelines to nudge our health care system toward long-term and widely-shared goals. These could include such things as payback requirements with forgiveness provisions for:

  1. Investments that yield more primary care physicians;

  2. Better chronic care management, as evidenced by low rates of hospital admissions or emergency department visits for treatable chronic conditions;

  3. Adherence to evidence-based guidelines of care, demonstrated by decreases in services known to have little or no clinical value and that place patients at risk of physical, emotional, or financial harm; and

  4. Limits on the levels of future price increases to private sector payers, already known to be significantly higher than government-sponsored health plans.

The pandemic is still with us. Its full economic impact lies ahead for most of us. The federal government has the opportunity to allocate taxpayers’ precious financial resources in ways that will best serve the American people and economy – ensuring a future in which all enjoy high-quality and affordable health care.

 

Warm regards,

 

Louise Y. Probst

BHC Executive Director


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COVID-19: What Do the Numbers Tell Us?

Posted By Louise Probst, Wednesday, May 6, 2020
Updated: Wednesday, May 6, 2020

There are so many numbers: testing, infections, hospitalizations, ICU capacity, recovery, and death. Reported daily, the data show the pandemic's impact on a worldwide, national, state, and county level, as well as specific settings, like meatpacking plants or other clusters. And on it goes, with additional tallies for those furloughed, unemployed, uninsured, and in food lines; federal recovery dollars distributed; the reduction in elective medical services; and projected health care spending. It can be confusing and mind-numbing. But what do the numbers tell us? And what can we do in response?

 

On Monday afternoon, I almost tuned out the reports of vastly higher numbers of people in the United States projected to become infected or die from COVID-19. Shared across all major news outlets, the statistics were stunning, predicting that the U.S. death toll could exceed 3,000 lives per day by June 1st, with the growth in new cases to rise to 200,000 per day, up from the current daily rate of 25,000. I felt a bit betrayed. We are all doing our part to prevent the spread by sheltering in place, wearing masks in public, and washing our hands. We had been assured that these measures were working – so what had changed?

 

Testing, which still lags behind what is need to meaningfully defeat COVID-19, has increased. Several clusters have been detected in meatpacking plants and other food processing settings. New cases throughout communities, many in the Midwest, have made it clear that the virus is still here and that the risk of transmission remains high.

 

Perhaps, lulled by early progress reported in flattening the curve, Americans have been on the move. Monitoring of cell phone locations has found people to be more mobile over the past few weeks. Several states have entered or are about to enter early phases of reopening their economies, despite failing to achieve the White House pandemic team’s recommended criteria to do so.

 

A caution offered by Milliman’s actuarial team during a recent presentation came to my mind and brought relief from any pending dread: “Models are rarely correct, but often useful.” These numbers are predictions – indicators of what could happen, but not what will or has to happen.

 

We must resist becoming numb to the risk, lulled into complacency, and overwhelmed by feelings of helplessness. We have the power to ensure that these assumptions are incorrect and never come to be. To see the latest tools to combat this disease, visit the BHC’s COVID-19 employer resource page and join us each Wednesday in May at 3:00 PM (CST) for a member-only COVID-19 Coffee Chat on evolving strategies. Each of us has a role to play, and together, we can keep ourselves, our loved ones, and our organizations safe.

 

Warm Regards,

 

Louise Y. Probst,

BHC Executive Director

 

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Rising to the Challenge, Staying the Course

Posted By Louise Probst, Wednesday, April 1, 2020
Updated: Tuesday, March 31, 2020

It has been two weeks since many St. Louis and national employers responded to the COVID-19 call to action: close workplaces for employees not directly involved in essential services. In almost lightning speed, and with the aid of technology and CDC guidance, HR teams prepared their workers to stay safe, connected, and focused while accommodating social distancing and this new way of life. I am impressed with employers’ agility and compassion in supporting their employees in the face of this significant health crisis. 

In the March 27th edition of the St. Louis Post Dispatch, physician leaders from local health systems (including BJC HealthCare, Mercy, SSM Health, and St. Luke’s Hospital) reached out to the public to share their insights, actions, and recommendations. With so much disjointed COVID-19 news, I felt reassured knowing that they are working together and coordinating resources and actions to meet the health care needs of the St. Louis community during this challenging time. The main takeaways from the collaborative statement were:

 

  1. "No Visitor" policies are consistent across hospitals. Please be understanding of the importance of these precautions in keeping everyone as safe as possible.

  2. Each health system has COVID-19 testing centers. Information about these centers can be found on their websites, along with virtual screening tools through BJC HealthCare and SSM Health. Unfortunately, supplies remain limited, so please call your hospital or health care provider ahead of time and understand that you may be asked to self-isolate at home, unless or until you have trouble breathing.

  3. Please continue to be vigilant with hand washing and social distancing. Remember to stay active, eat healthy, sleep well, and connect virtually with family and friends in order to remain healthy and resilient.

To support well-being, the Midwest Health Initiative continues to update the LiveWellSTL website with online and at-home resources to move more, eat better, lose weight, and feel well. BHC members are also encouraged to visit our COVID-19 resource page and join fellow employers for weekly coffee chats in April to discuss evolving responses.

 

While there is much that we do not know about COVID-19, one thing is clear. We are in this together, and everyone has a critical role to play in slowing the spread of this virus. Social distancing will be necessary for longer than initially expected. We must stay the course. We owe this to those on the front line of health care serving our community.


Warm regards,

Louise Y. Probst,
BHC Executive Director

 

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COVID-19: Public Health Tenets, Best Defense

Posted By Louise Probst, Wednesday, March 4, 2020
Updated: Wednesday, March 4, 2020

“SARS-CoV-2” is the virus that has claimed much of your team’s workday and that has been at the center of the world stage over the past several weeks. It is better known as coronavirus disease 2019 or “COVID-19” and is a new strain in a large family of viruses that can cause illnesses ranging from the common cold to pneumonia, and in severe cases, serious respiratory and kidney conditions that may lead to death.

 

Spread through sneezes, coughs, and contaminated surfaces, symptoms include fever, cough, and difficulty breathing. Symptoms can take between two to fourteen days to appear, suggesting that people may pass on the virus even before they aware that they are sick. Milder cases may resemble the flu or a bad cold.

 

While we learn more each day about the virus, how the outbreak will affect our lives is far from clear. This uncertainty creates stress and can make employees less capable of coping. Yet, all of us have effective tools to prevent the spread of communicable diseases. 

 

One of employers’ many roles is to help employees understand that frequent handwashing and other public health essentials are their best defense from COVID-19’s potential harms. Since mucous membranes are the passage ways of viruses into the body, avoiding the habit of touching the face (including eyes, nose, and mouth) without clean hands is critical. As a reminder, it is okay to warmly decline a handshake, as this may further protect people.

 

Another important employer responsibility is to develop and communicate benefit policies and business continuation plans should large numbers of employees become ill or public health officials call for social distancing. The CDC’s guidance to businesses and the public is a very good resource and can be found at this landing page.

 

At times like these, it is important to remain connected, learn together, and support one another. This is what builds resilience. One BHC member reported that they were considering waiving certain copays related to testing for the virus. Local health care providers have indicated that it would be very helpful for patients thinking that they may have the disease to consult with their primary care provider first and phone the facility ahead of time, so the team can be appropriately prepared and meet them at the door. Please share your learnings and interventions with BHC so we can pass them on. Stay tuned for an upcoming webinar featuring SSM Health's Chief Medical Officer and public health expert, Dr. Alexander Garza, and most importantly, stay healthy.

 

Warm regards,

 

Louise Y. Probst

BHC Executive Director

 

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The U.S. Can (and Must) Do Better: A Call to Action from the American College of Physicians

Posted By Louise Probst, Tuesday, February 4, 2020
Updated: Tuesday, February 4, 2020

Last month, the American College of Physicians (ACP), the nation’s second-largest physician organization, endorsed Medicare for All. It finds the status quo of the U.S. health care system to be unacceptable, rejecting the notion that it is too politically difficult to achieve needed changes. This position contrasts that of most other health industry organizations, who have taken actions to strongly oppose Medicare for All proposals.

 

The ACP calls for a transition to a full-scale, single-payer health insurance program or a government-run health plan, competing alongside regulated, private insurance plans. While ACP acknowledges that there are advantages and disadvantages to each approach, it believes either solution could achieve universal and affordable coverage, while realizing ACP’s vision statements for the U.S. health care system. ACP encourages other organizations to also make a serious and transparent effort to define what would make a better health care system, evaluate options, and recommend action. 

 

While ACP’s support for a single-payer system may or may not align with that of an individual employer, several of its vision statements are spot-on, particularly, ACP’s call for greater investments in primary care and mental health services. Employers recognize that having a primary care relationship can translate to fewer hospitalizations and emergency department visits, earlier diagnosis, reduced overall spending, and happier patients. Several BHC members have already taken steps to support their employees in accessing and engaging with effective primary care and mental health services, while others are in the process of working toward this aim. If your organization is interested in joining in these efforts, please let Lauren Remspecher know.

 

In order to better support members’ interest in advanced primary care and mental health services, the BHC is pleased to announce that it has joined the Primary Care Collaborative (PCC). PCC is a national, multi-stakeholder membership organization that facilitates connections, resource development, and research focused on enhancing primary care in the U.S. Learn more by clicking here.

 

Adding to this conversation, the 2020 BHC Spring Forum on April 30 will highlight opportunities for employers to improve mental well-being in the workplace. In addition to examining mental health trends and treatment innovations in the field, speakers will provide actionable strategies for suicide prevention, stigma reduction, and the application of health benefits, policies, and programs to create a culture of support. Register to attend by clicking here. We look forward to seeing you there.

 

Warm regards,

 

Louise Y. Probst

BHC Executive Director

 

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Landmark Antitrust Suit Settled: Game Changer for Anticompetitive Behavior

Posted By Louise Probst, Tuesday, January 7, 2020
Updated: Tuesday, January 7, 2020

Kamala Harris’ presidential campaign may have sputtered out, but an investigation that she initiated in 2011 has resulted in a settlement that is sure to have employers, insurers, and health systems taking notice, including many BHC employer members with worksites in Northern California.

 

Harris, then California’s Attorney General, began investigating whether Sutter Health’s market power led to predatory pricing and unfair financial burden on the people and businesses of Northern California. Sutter Health’s sprawling network of hospitals, surgery centers, and urgent care clinics makes it one of the nation’s largest health systems, with annual revenue of about $13 billion. 

 

The price hikes were striking in Sutter Health’s case. Health care costs in Northern California run 20% to 30% higher than in Southern California, with patient admissions averaging $4,000 more than at other hospitals around the state. A cesarean delivery in Sacramento costs $27,067, nearly double the price in Los Angeles and New York. Health care economists view Sutter Health’s actions as part of an alarming consequence of hospital consolidation that has resulted in higher prices. 

 

Harris’ successor, Attorney General Xavier Becerra, joined a class action suit by unions and over 1,500 self-funded employers. The case, expected to deliver about $2.5 billion in damages, was settled in October 2019. Details of the final agreement show that Sutter Health agreed to:

  • Make a $575 million payment to compensate employers, unions, and the state and federal governments, without any admission of wrongdoing;
  • Stop "all-or-nothing" contracting deals with insurers and cease anticompetitive bundling of services and products;
  • Limit what it charges patients for out-of-network services; and
  • Be subject to a court-approved compliance monitor to oversee its contracting practices for the next 10 years.   

We all know that initiating legal action such as this takes significant investment and fortitude. UFCW & Employers Benefit, the group of unions and employers who brought this suit, deserve our recognition. They said in a statement: “From the outset, our goal has been to not only achieve justice for the members of the class, but to also put an end to the anticompetitive behavior that has allowed Sutter to charge inflated prices.” 


California Attorney General Becerra claimed,
"When one health care provider can dominate the market, those who shoulder the cost of care — patients, employers, insurers — are the biggest losers. Today’s settlement will be a game changer for restoring competition in our health care markets."


While the impact of this case and the other pending anticompetitive suits will take time to fully appreciate, let us hope it spurs much-needed competition in health care. It is the first sign that courts and antitrust regulators are ready to focus on the impact of health care consolidation on the American public.

 

Warm regards,

Louise Y. Probst

BHC Executive Director

 

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Looking to 2020 with Appreciation and Optimism

Posted By Lauren Remspecher, Wednesday, December 11, 2019
Updated: Wednesday, December 11, 2019

As we end 2019, I would like to acknowledge BHC members' commitment to improving health care and employee and community well-being. Your engagement in the coalition and with each other is greatly appreciated as we learn and work together toward better health and health care value. This energy was demonstrated by recording-breaking registration numbers for our 2019 Annual Meeting, totaling 436 members and community partners. The conversations sparked by our national speakers and local thought leaders were full of opportunity.
 
Andy Waldeck, Senior Partner at Innosight, painted U.S. health care as an industry ripe for disruptive innovation. He explained that “disruption" is a change that will transform an industry and bring meaningful improvements in affordability and accessibility to its customers. While he did not offer a specific timeline for when such innovation would occur, he created confidence that transformation is coming to U.S. health care and highlighted opportunities for purchasers and providers to accelerate desired change and thrive in the shifting landscape. 

Dr. Reena Duseja represented the Centers for Medicare and Medicaid Services, perhaps the greatest disruptor of U.S. health care to-date, and offered insight into CMS' use of measures and incentives to expedite the value and performance of their plans. As with other innovations, employers can learn from CMS' experience implementing alternative models for payment and delivery of care.


Dr. Wendy Levinson, Chair of Choosing Wisely Canada and Choosing Wisely International, reminded us that "more is not always better," especially when it comes to health care. Using educational toolkits and creative messaging, the Choosing Wisely campaign offers practical tips for engaging patients and physicians in reducing the culture of overuse in health care. Dr. Levinson reminded us that this is a problem across nations, not just in the United States, and offered several examples of success that has been achieved in provinces across Canada, other nations, and in many medical schools. Along with the St. Louis Metropolitan Medical Society and the Midwest Health Intiative, BHC has been working to identity situations of overuse in regional data and prioritize possible target areas for attention. A community collaboration to tackle overuse through diverse stakeholder engagement is preparing to launch in spring 2020. The work will align with the BHC Board's priority to develop a communication campaign to help the public become more informed consumers of health care. We would welcome your team's participation in this important initiative - please contact the BHC if you are interested in getting involved.

 

Linda Brady, Boeing’s health care strategy leader, provided an update on Boeing’s Accountable Care Organizations, advanced primary care efforts, and other strategies to achieve better value. She underscored the importance of leveraging relationships with health plan or provider partners to understand and influence care enhancements for employees. While a direct ACO contract is not feasible for all employers, there are many opportunities for employers with smaller or geographically-diverse populations to leverage puchasing power for better value. Moving into the coming year, the BHC’s new Value-based Purchasing Roundtable will explore advanced primary care solutions, including a visit to two local sites that have taken this approach.

 

Incoming BHC Board President and Chief Operating Officer for Francis Howell School District, Kevin Supple, closed the Annual Meeting with a heartfelt reminder of how peoples' lives are impacted by employer-provided health benefits and the difficult challenges that are faced by many patients. He inspired all of us to use our influence to make health care work better for employees, their families, and our community members. The BHC looks forward to answering this call in 2020 in collaboration with you.

 

Warm regards,

Louise Y. Probst

BHC Executive Director

 

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U.S. Health Care System: Ripe for Disruptive Innovation

Posted By Louise Probst, Tuesday, November 5, 2019

The idea of disruptive innovation in health care gets a lot of buzz. Electronic medical records, interconnectivity, Accountable Care Organizations, and the Amazon, Berkshire, and JPMorgan partnership are just a few of the innovations that have promised to transform health care in ways that delight customers. So far, though, the public is still waiting.

 

According to Harvard professor Dr. Clayton Christensen, the hallmarks of an industry ripe for disruption are high cost and uneven levels of access. He explains disruption as a process by which “simple applications take root at the bottom of a market—typically by being less expensive and more accessible—and then relentlessly move upmarket, eventually displacing established market leaders.” Successful disruptive innovators are comfortable challenging the status quo. Examples of success from other industries illustrate the concept well: the iPhone, Amazon, Uber, and Airbnb, to name a few.

 

Could Walmart be health care’s disruptive innovator, decreasing cost and closing the care gap while wowing customers? In September, Walmart announced that it would begin covering costs for any of its 1.5 million U.S. workers who want to earn a health care degree. For a fee of $1.00 a day, employees can apply for bachelor’s degrees in seven different programs, such as health care management and supply chain logistics, and two career diplomas—as pharmacy technicians or opticians. The program will help the company recruit employees and also staff its growing line of retail health clinics. It’s the latest in a series of moves that show Walmart’s potential to disrupt our dysfunctional health care system, and perhaps, higher education as well.

 

Consider this: Together, Walmart and Sam’s Club operate more than 5,000 retail pharmacies, 3,000 vision centers, and 400 hearing centers, and provide low-cost Quest Diagnostics lab services. The big box behemoth is accelerating its push to co-locate health clinics by its stores, most recently launching a Walmart Health Center that offers a full menu of primary care, dental, and even mental health services to customers in the underserved region of Dallas, Georgia. Walmart says its new clinic will serve consumers regardless of insurance status and offer convenient, online scheduling and transparent, low pricing. Consumers can also access resources for preventive health and wellness.

 

Rising health care costs and poor outcomes disproportionately hurt lower-income and middle-class families. Walmart wants to bring affordable services to underserved people right where they shop, including preventive care for the chronic conditions that bust health care budgets. Their retail health care model could improve population health on a broad scale while putting downward pressure on prices. If they succeed, that could be a game changer for our health care delivery system.

 

Join us at the 2019 BHC Annual Meeting to learn what employers can do to spur disruptive innovation in health care.


Warm regards,

Louise Probst
BHC Executive Director


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Advancing Primary Care: Interventions to Support and Replicate

Posted By Louise Probst, Tuesday, October 1, 2019
Updated: Tuesday, October 1, 2019

For half a century, the U.S. health care system has undervalued and underpaid primary care providers relative to other specialists. The unintended consequences of this chronic underinvestment loom large: out-of-control cost, declining and inadequate access to primary care physicians, outcomes that lag behind other nations, high rates of overuse and medical mistakes, and growing evidence that financial incentives too often drive clinical decision-making.

 

According to the Patient-Centered Primary Care Collaborative (PCPCC), overall U.S. health care spending on primary care is assumed to be between 5% to 7%, half or less that which is spent in other developed nations. A recent study by the Milbank Memorial Fund found that primary care spending in Medicare was only 2% to 4% of its overall spending.  

 

Yet, considerable evidence has shown that a strong primary care foundation is essential for a high-performing health system. By example, regions with a higher ratio of primary care physicians have better health and lower rates of mortality from heart disease, cancer, stroke, and other causes, even after controlling for sociodemographic measures. Data from the Midwest Health Initiative confirms that commercially insured patients in St. Louis who regularly see a primary care physician are less likely to visit the emergency department.

 

Since it takes about a decade to train a primary care physician, and demand for their services is growing faster than the supply of new primary care providers, the time for action is now. Below are examples of truly meaningful strategies that warrant our attention and support.

 

(1) CMS recently announced that it is considering using different E&M (Evaluation and Management) codes for primary care and medical subspecialist physicians compared to those used for surgeons and other procedure-based physicians. The use of separate codes would enable CMS and private sector payers to begin to rebalance payments by offering higher increases to primary care providers, without automatically increasing reimbursements to other specialists. These codes would also better enable measurement of primary care spending relative to other specialties. On behalf of employers, the BHC recently offered its support for this proposal to CMS Adminstrator, Seema Verma.  

 

(2) State governments are taking real actions to require greater investment in primary care. By example, between 2009 and 2014, as a condition of having their rates approved, Rhode Island required commercial insurers to raise their primary care spending rate by one percentage point per year (in ways other than by increasing fee-for-service rates). The state’s primary care spending was 5.7% in 2008 and increased to 9.1% in 2012, while total health care expenditures fell 14%. Check out this quick summary of Rhode Island’s and five other state's efforts. 

 

(3) The PCPCC issued a call for a consensus process to define a common definition and standardized measurement of primary care spending. This would enable the value of primary care to be quantified over time, as well as comparisons across states, health plans, and accountable care organizations. It would also help guide future investments and the evaluation of new value-based payment models across payers and payer types. Read PCPCC’s call to action here

 

The BHC recognizes that many of its members have taken action to strengthen primary care through ACO arrangements, worksite clinics, or other health plan programs. If you are interested in sharing what you are doing or connecting with others on this path, please let me know. 

Warm regards,

Louise Probst
BHC Executive Director


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