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Transcript

Ben Markland: Hello everyone, thanks for joining us in this month's installment of the Insurance Leadership Podcast. Today we have a very unique guest with us. Tiffany Ryder. She has quite the story. She actually started out in a poor rural upbringing is what she's told us with no access to insurance at all. So we're gonna talk to Tiffany a little bit about how that journey led her through all these different steps in her career. She's gone from an NFL cheerleader, she lived in Europe. She worked in the ER during COVID, she's done clinical research, she's a patient advocate, she's a health policy expert, so she's done it all. And also she has about 20 different companies that she's associated with, and I can't list all those either. I wanna meet with Tiffany. Just ask you a little bit about your journey and how this has gotten you from a poor, rural Louisiana girl to, a jack of all trades and someone out there [00:01:00] really trying to push change in this industry. Tiffany, I tell you what, let's keep it real simple. Tell us a little bit about yourself. I know I kinda hit the bullet points there, but tell us what you got.

Tiffany Ryder: Yeah, so first I have to say thank you so much for having me here. I love meeting new people and having these types of conversations. Truly Thank you. All of those things that you said are true, and certainly my career has been anything but linear. I think that the fact that I did come from this background that was rural and low health literacy has really colored, everything that I've done since then, I actually got married to a man in the military when I was 17 and moved to Maryland. Ended up starting a family at 19 and I think that was when I first had my first, I don't know transformative moment of who do you wanna be? What do you want, your life to become and I found myself in a doctor's [00:02:00] office. Overweight, wasn't even pregnancy weight at that point was just not doing well. And the doctor did some blood work and said you have this thing called PCOS and you have pre-diabetes and what we're gonna do is we're just gonna watch it and then one day, you'll come in, you'll get blood work and you'll have diabetes, and then we'll just give you some medicine from then. And I said, okay. I didn't know anything and it hadn't had a lot of experience with doctors and thought, if the doctor's saying this must be how it is. And found myself in this position where through looking for something bigger to do, I fell in line with some people who were working out at the gym and they were like, if you really wanna be, an NFL cheerleader if you really wanna do something big, which is what I decided, sounded like the biggest dream I could imagine. They said you probably should, get in shape, and maybe lose a little weight, you look great, this is what you're trying to do and you wanna be an athlete, this is how you do it. I said, okay. So I lost the weight, I made the team, I did all that. But the point of this [00:03:00] story and how it's related to healthcare is that throughout that process, I predictably lost this pre-diabetes diagnosis and lost this PCOS diagnosis and found that, my health was completely fine and I wasn't actually gonna develop diabetes. And I think for me that was essentially the transformative moment where I realized that these people that I held on a pedestal actually didn't know everything and that there was more to the story than we really had access to. And anyway, it's been downhill ever since. That's been my mission to help people understand that we don't know what we don't know, but that there's a lot that you actually have power and control over that patients don't necessarily realize.

Ben Markland: Yeah. No, that's great. So tell me a little bit about you chasing this mission. Are you focusing on the pharmaceutical industry, are you focusing on insurance? Are you focusing on the doctors? Are you focusing on [00:04:00] just people taking, it sounds a lot like you're focusing on people taking control of their own health. But I know there's obviously a lot of pieces to the pie there.

Tiffany Ryder: Yeah, so I think that, the advantage, you asked me a question and I answered my why, but didn't say, really how it equipped me here, but the fact that my career was non-linear. Put me in a lot of different rooms to see healthcare and life from a lot of different perspectives and as an NFL cheerleader, I learned how, to sit in a room with powerful people and represent your brand and navigate these high pressure environments, and then when I moved into emergency medicine, when I retired and was in Europe and looking for how I was gonna end up in, a medical space to help people. Emergency medicine was interesting because, that's where the most vulnerable people were, right? Whether no matter where you are on the [00:05:00] socioeconomic continuum or on the health continuum, when you're in the emergency room, you are extremely vulnerable and that was really interesting to me. And from there, I went over to fiduciary consulting because I said it seems like we're not really fixing things in the emergency room, we're like saving people but it's just temporary and then we're bankrupting them and there's a lot of issues with access to care, maybe I can fix it from over here. And then, from there I realized that being an insider in the ER, wasn't really it didn't gimme the impact I wanted. Being an insider in industry, in the business side of healthcare also wasn't really allowing me to help people the way that I dreamed and wanted. And so I'm back to this storytelling and advocacy and shining a spotlight on all different areas where it matters. So it's not just about teaching a [00:06:00] patient how to ask better questions when they're in the emergency room, it's also about teaching them well, what is the value of primary care? And can my cardiologist actually treat my blood pressure better than a primary care doctor can or, I own a small business and I need to provide benefits for my employees. What metrics should I be talking to the PBM about or my broker about in order to make good decisions that are gonna lead to good clinical outcomes? So I have an interest, I have a generalist knowledge in a lot of areas. I am certainly not the expert on PBMs or health plans in general, but I know enough to help people ask better questions, and so I'd say I have my hand in a lot of different areas.

Ben Markland: Yeah. No, that's great. I think that's a place that us as a culture, we really [00:07:00] missing the boat. When you say asking better questions I think a lot of people don't ask any questions.

Tiffany Ryder: Yes.

Ben Markland: There's a blind trust of your doctor and your pharmacist and that they're treating you properly and they're giving you the right prescriptions and, to the fiduciary side it's the right thing that makes sense. I actually have a funny story, it was last year when my son he got strep throat twice in two months. And I don't know why we got the bill and, they treated with penicillin just like they have for the last whatever, a hundred years. But the cost of it had gone up shockingly like five times. And my guess is the doctor that prescribed it to us didn't even know that. And, is there other antibiotics you can treat a strep throat with absolutely, but the difference between something costing $5 and $250, that's shocking. And the fact that, us as a family going in. You get the prescription, you go fill it, and you get the bill three months later, right? Do I know what it was gonna cost? No. Did the doctor know what it was gonna cost? Maybe not. Those are the questions that as consumers, if [00:08:00] we're shopping for a pair of socks on Amazon, we're probably looking at prices the first thing we're doing but there's zero transparency in what we're doing when it comes to our health. So I think that's a very heroic role you're taking there with your mission.

Tiffany Ryder: Yeah. And that story is not uncommon in any way and that is, so now I have to tell a story that's a great follow up for this, but there's a lot of finger pointing in healthcare and we talk about things like health reform and then, we just point the finger at whatever area isn't ours. And I do see a lot of people pointing the finger at the doctors. And I love to tell the story about when I was in school, I was sitting in a pharmacology class and we learned about UTIs, which is a bladder infection, it's pretty common. And and they were, the doc was going through the different drugs that you can use for UTIs. And some of them only, were best suited for specific situations but if you had a 22-year-old who comes in with a bladder infection. There are like several standard options. [00:09:00] So because of my background, I raise my hand and I say, awesome. I'm so glad that all of these options are equal. So how do I find out how much it costs? Because I'm planning on, practicing in rural emergency rooms and, some people don't have access to different medicines like, how do I do that? And I was scolded. I was told it is not your job to be someone's CPA or their finance manager in a very snarky way, it is your job to provide the best clinical care. And then, I can't, this is the moment when I was supposed to shut up, I can't shut up. I said, yeah, but what good is clinical care if the person is never gonna go pick up the prescription from the pharmacy? Or if they can't afford, I don't know, to buy milk the next day or, pay their car insurance because I prescribed a drug when I could have prescribed something that cost $5. Yeah. Anyway, and [00:10:00] eventually I never got an acceptable answer, eventually I shut up and, realized that I was on borrowed time in medicine if this is what clinical practice was, and I think that a lot of clinicians find themselves in that space where they realize that learning about the system is that's on your own time. After you're done charting, after you're done checking the boxes and working over time for free. That piece is on your own time, and I think that lends to a lot of the issues that we see in the marketplace.

Ben Markland: That's right. I think it's funny they use that term, but as a consumer, if you need to consult a CPA to treat something in your body there's a problem there. And the system's broken. And I think we can all agree. McDonald's doesn't sell the best tasting hamburger in the world, but they sure sell a lot of them and we know the reason, right? It's 'cause it's price. If I can take control of my health but have the transparency to know that I can financially navigate this I think that really empowers people as consumers. And there's a [00:11:00] whole bunch of other industries where it's a given and for some reason culturally. In medicine it's not there. There's no expectation. So it's interesting and I think, if you look at the political landscape, I think politicians are starting to they've got a target on that. And I think we're probably gonna see change. It may come slow and difficult, but I think we're gonna see change eventually. I hope we do.

Tiffany Ryder: Yeah, for sure. And I think the problem is, has managed to snowball and worsen at a rate that's completely unsustainable. When I'm working in the emergency department, it is not just a population of people who can't afford care, other places that are there. It's people with Mercedes fobs that are waiting 24 hours right next to someone who, might be homeless or right next to someone who's uninsured. So it is the full gamut of society that's being affected. And I think that is going to have a positive impact on [00:12:00] the rate of change, on the rate that we see different things being tried.

Ben Markland: Well, Tiffany, let's get back to you a little bit. So this is the Insurance Leadership podcast. So I wanna hit you a little bit of leadership question. And I know you touched on a few defining moments, one of them being sitting in the doctor's office as a young mother or being young and pregnant, but I like to say, looking back, have there been any real defining moments throughout your career that have shifted your perspective on leadership?

Tiffany Ryder: I think there have specifically. When I was working in the emergency department, I developed this, I don't know, this habit of thinking about my patients all of the time, even when I was off shift and some anxiety and I was, I really thought through how do I manage that? And so I developed this habit of going into every shift about an hour beforehand and calling a few of the patients that I had seen, on the previous shift and just checking in on them and saying, Hey, how's that infection going? How are you doing? And [00:13:00] one night I go in, I went in at 8:00 PM my shift started at nine. So calling this guy, he was a young guy in his twenties and he'd been bitten by a little kitten. So he had come into the ER, he had the beginnings of an infection from this cat bite. And I'd given him, the rabies shot and some antibiotics and sent him home. So I call him and I said, Hey man, how's it going? Like, how are you doing? And he said actually I'm not really doing so well. I've got a fever and I've got some pretty serious swelling in my arm and I'm having trouble like moving my fingers like. All super red flags, super scary things for me to be hearing on the phone. So I'm trying to like, I'm like looking through the chart, did I prescribe the wrong antibiotic? Like what is happening? So we get down the conversation and I'm like, dude, I told you had to take that antibiotic, so did you get it? Is everything okay? And he says actually, and [00:14:00] this is again in a rural area of the northeast. He says actually, my insurance will only fill prescriptions at CVS. And they said, I can't go anywhere else. And the nearest CVS is, 40 minutes away. And I'm sharing a car with my wife and like the story was basically, I had done all the things right. He had done all the things right as far as like getting to the point where we were, but this man wasn't able to pick up, I don't know, a $20 prescription because of the way his plan was designed. And I think for me that was the wake up call that had happened several times before, but it was this young man with a cat bite, that really hit me that the real crisis wasn't that clinicians weren't spending time with their patients, it wasn't that patients weren't always seeking care in time, it was a financial and a structural problem. And I think [00:15:00] that's when I knew that the impact I was gonna have from inside clinical care wasn't gonna be enough and went over to the fiduciary side because I really could see that the place we needed to be standing up was in this uncomfortable gap between, where medicine is and where patient care is and where it needs to be in order to control, costs and clinical outcomes and actually serve people. And and that was the gap that needed to be closed. And that's definitely what I'm trying to do.

Ben Markland: Do you have thoughts on how we can do that? One of the questions that I have is you talking about patient education. And, what role or what initiatives do you think that leaders in this field can take to move the needle towards that end goal?

Tiffany Ryder: There are, depending on which stakeholder we're talking about, there are a lot of different angles to take. Something that I talk a lot about is direct primary [00:16:00] care, I think it's one of the bright spots of all the things that we're trying in healthcare to make things better. Direct primary care is just a primary care, I know, but for anybody who's listening that may not be familiar with it, it's just a primary care model that instead of going through your insurance company and you go to the doctor and then the insurance company pays the doctor and this whole thing you basically just go to the doctor and you say, Hey, how much money can I give you to see me whenever I need care? And there's a subscription model, Netflix and for me. It's about teaching patients that the way to get better care, might be outside of the box, right? It might be direct primary care for a broker. It might be teaching the employer like, Hey, I'm looking at your claims history and you really shouldn't be spending this much, but it looks like you've a [00:17:00] ton of young people going to the emergency room for non-emergent care. What could we do about that? And being able to look at what's not working and say, oh maybe they need better access to primary care so they don't have to take off work. How do we get access to better primary care? Is it that their primary care can't see them? Is it that they don't understand the value of primary care, so they're going to cardiology in the ER? So I think it's about really taking a step back and talking with people and finding out what they're struggling with, looking at the data and then coming up with, smart ways to solve the problem instead of what I see a lot of stakeholders doing, which is, oh, let's just throw more money at the problem. Let's just, we just have to spend more. This amoxicillin is 250 bucks, that's just what it is. And I don't think that is sustainable anymore or is it the best way [00:18:00] for patients to get great care. Ben Markland: And then obviously that the dominoes start falling when that happens, and a lot of the audience for this podcast are insurance brokers and their job is, okay, Mr. Employer's coming to me and they've got a 35% rate increase because of their spend, and now we've gotta start going around and shuffling and figuring out, Hey, what's a strategy to get this premium down, or save them or put in some gap insurance or whatever else they can do there.

Tiffany Ryder: Yeah.

Ben Markland: I agree, if we could get back to the root cause of all this, I think, it makes obviously everyone's jobs easier and.

Tiffany Ryder: And to your point, patient education is essentially. It's the foundation of any functioning healthcare market.

Ben Markland: Yeah.

Tiffany Ryder: Like we can't have an uninformed patient just running around getting terrible care and being taken advantage of. Of course that's profitable for all of these other stakeholders, but it's not good for them, it's not good for their employer, and I think that just doing simple things like investing in plain language content. Making [00:19:00] pricing actually transparent, helping a patient understand that their financial commitments are different depending on how they do care. Giving them decision support tools that actually work and are understandable for them I think all of those things are the low hanging fruit. Honestly, that isn't. Always being addressed. And I think that we put things in front of employees or patients, right? And we say, Hey, here's a whole bunch of resources, here's a whole bunch of benefits and stuff. And they don't use it 'cause they don't know how to use it, it's all way more complex than they think it is. And we don't spend that time really closing the gap between, Hey, what do you actually need? What would actually help you? What can I do to help you get whatever care or prescription, whatever it is that you need. And then how can I walk you through that door to where it's less confusing and less cumbersome and just make sense for them.

Ben Markland: And who in this person's [00:20:00] world do you think is best equipped to walk them through that?

Tiffany Ryder: That's a great question. I think that there are certainly in this new. Age of, text messaging and I know text messaging isn't incredibly new, but text messaging and TikTok and like short form content that is being thrown at people, I think that people are getting to a place where they consume information a lot differently, there's a lot more information available to people and I think it starts with this almost digital first strategy, right? Of course, I think that there is huge value in your HR teams that are on the ground communicating with people. But, going to A-C-H-R-O and saying, Hey, I'm gonna need your team to spend 500% more time doing this thing. That they're already frustrated that they have to do because it's not [00:21:00] their job to be a patient advocate or what have you, is a non-starter. But I think that if you've got assets, if you've got digital assets, if you have things that people are interested in, if you tell me, Hey, I know you're sick of taking off work to bring your kid to the doctor every time they have an ear infection. Here's how we think about ear infections, right? Like I'm gonna watch that 32nd, 62nd video. 'cause I don't like giving my kid antibiotics and I don't like taking off work the whole day and like I don't like seeing my kid in pain at two in the morning and going to the ER. So I think figuring out what the employees or the patients actually need that would change things for the better for them, buys you trust. And also gives you data on what is interesting to them, what will make their healthcare journey have better outcomes and cost everyone [00:22:00] less money. And I think the center of all of that is primary care, which is again, why I am always never worked in primary care. I don't own any stake in a direct primary care business but this is why I push direct primary care so much because, what if the easiest solution is here's some information on how you can navigate your health and your family's health better. And if you need some help with that, we've contracted with this really smart human being over there and they are actually gonna help you navigate the system, not just the clinical part, but also when do I go to a specialist? When do I go to urgent care? When do I go to emergency care? And whether it's digital information or it is making sure that they have close contact with a primary care person who is aligned on their side. I think that those are probably the best two approaches that I'm seeing working well.

Ben Markland: Do you believe as an employer [00:23:00] incentivizing employees to take advantage of these things would be, is something that makes sense? If I think back, I'm thinking 10 years ago, I know the wellness programs were a big buzzword and really gone away. I know actually even my own company, we did one and, it was something put together by our insurance carrier and if you checked enough boxes, you get, $15 off your premium each month and, unfortunately, it's sad but people's health isn't incentive enough for a lot of them to take action. But, their wallet or their pocketbook is, and the thing was it was unfortunately it was easily gamed. Check a box that says you ran two miles today, right? Now fast forward 10 more years and I know there's healthcare companies starting to integrate fitness trackers and, GPS and so they can actually see that, what's the gym? The one orange theory where your heart rate's posted up on the wall and your heart rate becomes a competition with the rest of the people in there, which I think is scary 'cause it's like, Hey, who's gonna die first in here maybe, but nonetheless, almost either [00:24:00] incentivizing or maybe gamifying your own wellness, do you have thoughts on that or is that something you have interest in?

Tiffany Ryder: I definitely have thoughts on that I think that gamifying things is always a good approach. I think that the data is mixed on how much these different, wellness programs work. Even ones like you described, like that would totally work for me, because I wanna die first.

Ben Markland: Right? Yes, exactly.

Tiffany Ryder: We're in the orange three I'm gonna win this one because I'm gonna just do it until I pass out.

Ben Markland: Yeah, I love it. Competition drives things for me.

Tiffany Ryder: Yeah, but that's not where we all are.

Ben Markland: Sure.

Tiffany Ryder: That's not I don't think that's a one size fit all approach. I do think that the sort of the future of healthcare is gonna, really move towards unbundling just like we do for, pretty much everything else. I don't think that this one size fits all to an insurance model is gonna work in the long run. And I think that just going to [00:25:00] people and being honest has the best returns. Again, direct primary care. I have seen I've talked to brokers who say, oh we put this into our plans and if you go to the direct primary care doc, then there's no copay, there's no charge. But if you go to, whatever else. You're a normal doctor that's covered by your insurance, there is or whatever. And we get a lot of pushback for that sometimes because fill in the blank, right? People feel like they're being controlled, it sounds like an HMO and they don't know why they hate HMOs, but they definitely hate HMOs or

Ben Markland: They heard they're supposed to, right? Yeah.

Tiffany Ryder: Or, okay, why does my employer want me doing this? There's gotta be something in it for them. I'm getting screwed. No, I'm gonna go to this, this other person and that's just what I'm gonna do. So I do think that there's this is not like without friction, but at the same time, going [00:26:00] to someone and saying, look, we value this care because it's so awesome and when our employees go to this particular doctor, they don't have to wait for two hours to see the doctor for a five minute appointment and then have to go in three more times because the doctor has more time. And we've looked at the data and people that see this primary care doctor are less likely to end up in the emergency department and feel happier and blah, blah, blah. And if you're not in the ER or you're not in the specialist office when you don't need to be, we pay a lot less money for your plan. So of course, yes, it does benefit us and in these ways, but it also really benefits you and we really want our employees to be really well taken care of. I just feel like that is an argument. That people will listen to with skepticism perhaps, but [00:27:00] I don't see any issue with incentivizing things especially when it's super transparent. What's in it for the employer, what's in it for the broker, what's in it for the employee? And then everyone is essentially just participating in real informed consent and I think that has huge potential to be successful.

Ben Markland: So from a broker's perspective, what do you think would be some pressing issues that they may need to be suited up for? What where do you think, coming down the pipeline, and I know you're talking a lot about change that you'd like to see and I think, we're in agreement, it's for the greater good of everyone, but where does a broker you think need to be positioned for some of this change or some of these issues that you're speaking about?

Tiffany Ryder: Thoughtful discourse is always important, right? We all get in our own echo chambers. I, myself am also guilty of it, but, paying attention to what are the changes coming up? And not just the ones that align with whatever your political ideology are or your [00:28:00] pocketbook. But being aware that there's bias, and that fighting against that is the best way to see the landscape for what it is. I think that misaligned incentives are at the center of everything really that's wrong in healthcare. And things like ditching commission-based models, for brokers is important, or moving to, fee for service or being transparent about where the money flow in your own business is gonna become increasingly more important the more we see lawsuits on the fiduciary side. Maybe you as an individual aren't at risk, but I almost feel like it's an opportunity to prove that you are a believer in transparency and accountability and not just for PBMs and TPAs and hospitals and doctors, but like for yourself also. So I think like knowing how the [00:29:00] money flows and then being as transparent as you can with that is also important. I have some very good friends who are brokers who operate in the fully insured space because, when they're serving an employer that has five clients and they, that's how they are choosing to help them. They have to be honest about we are gonna have access to these forms of data and we are just never gonna have access to that form of data. But the more transparency and the more upfront. I think that brokers are about why they're suggesting different courses of action, just like your doctor should be very upfront with, I am recommending this particular treatment option because I think it's best for you because of A, B, and C. The more that happens. The more that employers and [00:30:00] employees are going to trust what we say. And I think that is probably the biggest tool we have in our toolbox and the most important one as people are growing increasingly mistrustful of the healthcare system in general.

Ben Markland: That's right. Oh, I agree with that. Look, Tiffany, let's get close to wrapping it up here. I'm curious your thoughts on what a broker, maybe a carrier or even a consumer what you think your suggestions they could do to drive real change. What are some actionable steps? And I'm curious from the broker standpoint, which you just answered a little bit, but also from a consumer standpoint and maybe even, we have a lot in this audience as well of just business owners, hey I know you mentioned that the business that maybe has five employees, they don't have an HR department, you're the owner, you are the HR department, you're choosing the insurance, you're doing it all. So for those players, what do you think are some actionable steps, that could drive real change from your own experience? I know this is a lot about, what your personal [00:31:00] mission is, so let's close it out with you saying, Hey, here's Tiffany's three steps to success.

Tiffany Ryder: Yeah so, I don't know if I can condense it to three steps, but I'll try real hard. So I do think that an emphasis on primary care matters. People are skeptical of primary care. Nobody, oh, that was hyper hyperbolic. Hold on. A lot of people struggle to see the value in primary care because it has been reduced to a five minute appointment so, anything that you can do to access, good primary care where you actually have a clinician who can spend time with you, whether it's you personally, if you're the employee, or your employees, if you're the employer or your client's employees, if you're the broker. I think that is huge, that would make the biggest difference in, and healthcare above anything else that we do. And I think that direct primary care is absolutely the best way to do that [00:32:00] because it puts the patient back in the center of care, right? Everything else that we do whether we're healthcare providers or brokers or any other stakeholder, we're playing games behind the scenes around the patient. And then, trying to do it in the best way that we can, but the patient is not really in the center. It's our contracts, it's our gag clause, it's whatever it is. And so getting primary care back in the center and lifting that up, no matter where you are, even if you're an employee and you just say, I'm gonna go pay 75 bucks a month for direct primary care and not use my insurance because I need this access. So that I can be the best that I can be. I think that is an option, that's certainly what I do. From the broker and employees or employer side, I think doing, simple things like auditing your PBMs, looking at your TPAs, [00:33:00] like where is this money flow going? Are the contracts transparent? Are you doing things, as the expert and positioning yourself to be able to make ethical decisions, 'cause it's really easy to get yourself into a situation where you're trying to do the right thing, but there are forces that are, aligned against you doing the right thing. And demanding the transparent contracts from those entities. And then the last thing I would say is. Look at companies, and this is bias on my account. I'm a member of Crowd Health, which is a, like a peer-to-peer funding network that really, it is just not insurance at all. And I chose that route 'cause I wanted to try something different. Try your independent pharmacy. Go there, it doesn't matter if it's not associated with your insurance, go there and say, Hey, I take X, Y, Z medication every month. [00:34:00] How much would that cost if I just paid you in cash? And then do the same thing at CVS. So be willing to step outside of the box and outside of the way that things have always been done. Because I do think in this climate, the only way to lose the way you're gonna lose to all of your competitors as a broker, the way you're gonna lose all of your patients as a clinician, the way like your health is gonna suffer as a patient. It's all the same thing. The guaranteed way to lose is just doing things the way they've always been done because we are very clear that's just not working and it's working increasingly poorly but, we have the opportunity to innovate and companies are emerging that are innovating, regulation at a much slower rate is also changing, as you mentioned. And I think that whatever the best future is, whatever the next steps are, they're not gonna be what we've been doing and so [00:35:00] staying open and willing to investigate and try new things is gonna be the only way to survive.

Ben Markland: That's fantastic. Tiffany, we appreciate you joining us today. I think it's great what you're doing. There's a lot of walls to be broken down.

Tiffany Ryder: We really are.

Ben Markland: Good to know we got Tiffany up.

Tiffany Ryder: And this's how we do it.

Ben Markland: Yeah, absolutely we appreciate it. And for everyone watching, we appreciate you guys taking the time out to watch us this month and we'll see you next time.