- Season 1
- Episode 5
Rich talks about how the tech landscape within hospitals requires a different approach to selling a disrupting technology, the competitive advantage Kermit has created by delivering cloud-based software that still protects sensitive patient data that’s governed by HIPAA, (the Health Insurance Portability and Accountability Act), how Kermit transformed from a consulting service into a software-enabled offering by harnessing low-code, how Kermit has successfully digitized and mirrored previously broken workflows in hospitals rather than introducing completely new processes, and finally, insight into how low-code is guiding the future of their product offering.
/ Mark Manning /
Welcome to Make/Shift. Mark Manning here, Customer Evangelist at Mendix. We’re here to explore how your peers have adopted low-code, and the pain points they’ve addressed with the platform. We’ll take an authentic, unfiltered look at the solutions our customers are building to digitize their processes, to deliver much-needed solutions to market more quickly, and to cut down the cost of development.
On today’s episode we chat with Rich, the CEO Kermit, about how the tech landscape within hospitals requires a different approach to selling a disrupting technology. We talk about the competitive advantage Kermit has created by delivering cloud-based software that still protects sensitive patient data that’s governed by HIPAA, the Health Insurance Portability and Accountability Act, how Kermit transformed from a consulting service into a software enabled offering by harnessing low-code, and how Kermit has successfully digitized and mirrored previously broken workflows in hospitals, rather than introducing completely new processes. And finally, insight into how low-code is guiding the future of their product offering. So Rich, could you tell us a little bit about yourself and your role?
/ Rich Palarea /
Sure. I’m one of the co-founders, I’m also the CEO of Kermit. And my background is a little bit different than what you might expect from a medical device software cost reduction company. I actually have a background in spend management in logistics and in supply chain. This is an interesting organization that we’re a mashup of a couple of different disciplines. I met my two co-founders, Jason and John, who are former medical device reps, and so that’s how we got into this space.
/ Mark Manning /
And could you speak about your product itself, Kermit, what that product does, who it interacts with, its growth over the last couple years?
/ Rich Palarea /
Kermit is a spend management platform built on Mendix, and we sell this to hospitals and health systems throughout the United States. It tracks the surgical billing that is produced inside of an operating room in most hospitals who are doing total joint, spine, cardiovascular, really any type of surgery that involves an implantable medical device. And I think what might be interesting for you to note is that there is a salesperson for the medical device manufacturer standing in the operating room with the surgeon during the surgery. They’re not part of the hospital staff, and they’re not a surgeon, and that’s quite alarming to some people, but this is how it’s been done for 50 years, and that person plays a very important role.
And so, their responsibility is to make sure that the surgeon has everything that he or she needs during the surgery, and that they also understand how the technology works, how the implants fit together, how the instrumentation works, etc. What the surgeon doesn’t see is any type of price tag on the box for the implant that’s being sold to them by that salesperson who is actually earning a commission for that sale.
And so, what Kermit is doing is it’s actually adjudicating all of the invoices that are being generated from that transaction. And by housing the hospital’s negotiated prices, in the form of a pricing file and a contract, we can tell the hospital literally in real time, what’s okay to pay on that particular surgery and what isn’t. And the reason why this becomes a significant problem, you’ve got these parties who are on the one hand, the surgeon who is ostensibly buying the implant, they’re using it for their patient, they want the best possible outcome for the patient.
But then you have the hospital who, on the other hand, is actually having to pay for the implant and may not understand the clinical implications of why the surgeon used what he or she did. So you have this interesting triad, if you will, of buyers here and what Kermit is doing is, like I said, in real time, it’s actually screening all of those invoices and telling that buyer, who doesn’t have any understanding of why the surgeon used what he did, what’s okay to pay him what isn’t. Was there an extra screw placed on there that nobody has visibility to? Do I pay for drill bits or are they free? A number of different rules that can be adjudicated on the fly, if you will.
/ Mark Manning /
How’s that landing in the marketplace, in terms of maybe geographic growth, or company growth, or the value that you can deliver it to these hospital systems?
/ Rich Palarea /
Hospitals for a long period of time actually, have not really managed this in any collaborative way. So our messaging really is that we’re trying to produce a partnership, if you will, between the surgeon who is using the implant, the supply chain executive, who is tasked with negotiating the prices for those implants and may or may not have the technical expertise to be able to do that. I mean, if you think about what they’re doing, they’re negotiating everything for the hospital, they are the buyers. So, everything from protective equipment, gloves, and masks, and large capital purchases like x-rays and MRIs, to these very technical implants.
And then the third party to that in the hospital is the financial executive, the CFO, the VP of Finance, or even the CEO in a small hospital, who really is going to be scratching their head frequently wondering if these cases are even profitable for their hospital to perform for their patient population. We’re producing this collaboration, so this solution is fairly well received for that reason. We’re producing this collaboration between those parties. The other reason that I think we’re having some success in our growth is that we offer this, in the marketplace, basically at no risk to our hospital customers. In other words, we will tell them they can use our application and we won’t charge them a subscription fee if they would like for us to participate in the renegotiation of any one of these service lines.
For example, let’s stick with knees and hips for a moment. If they’ll allow us to participate in that, what we will do as consultants is, they can outsource that entire category to us. We’ll do the request or proposal, we’ll issue those bids, we’ll manage them as they come in. We’ll do all the analysis, all the negotiating, and even do the contractor review. And in exchange for all those services, we’ll actually take a portion of what we’re able to save the hospital as our fee. So there really is no risk for a hospital to engage us, and then they get all the analytics, all the reporting, all the data collection, all of the audit and compliance that I mentioned before. And that’s a pretty easy proposition for a hospital CFO, for example, who’s trying to manage budgets and doesn’t have a couple hundred thousand to budget for a new software subscription. And they’re paying far more than that for a lot of the enterprise software that they buy such as their electronic medical records.
We’ve concentrated mostly on our growth here at home. We’re located in the Baltimore suburbs of Maryland and our target market has pretty much for the past nine years, been the Mid-Atlantic. We’ve grown nicely, we now manage 40% of the implant spend, which transacts within the state of Maryland. So pretty sizable amount of the transactions here. And I would say, if I could boast, just I think we have fundamentally reshaped how this category is managed and negotiated here in and around the Mid-Atlantic region. Now we have our sites focused on taking this out to a national stage. Nine years into this, we’re actually finally considering a series A venture capital round to help us grow the company. But we have done quite well thus far, we’re at $9 million in revenue, a total of 12 full time employees. And most of what we’re doing is all remote, actually, here from Maryland.
/ Mark Manning /
And you’re stepping into an environment in these hospital systems in a process that, sounds like for the better part of four or five decades, has just not been digital. How do you and the team think about the technology choices that you have to make to ensure that you can absorb that process and change it for the better?
/ Rich Palarea /
Yeah. Mark, that’s a good question because these hospitals actually are fairly new, when you think about the whole technology landscape of all industries in the U.S., and even worldwide who have adopted technology for various different things, hospitals are just now kind of getting into that game. And they’re also experiencing quite a bit of a sea change with the way in which they’re trying to manage their financial livelihood. In the past you might’ve thought about a hospital as, for example, a charitable endeavor. Many, many hospitals have a Catholic affiliation, for example, or other religious affiliations, so that’s quite common.
But now we’ve moved into this paradigm where hospitals are seeing a dramatic change in the way that they’re being reimbursed, different models being proposed by Medicare, Medicaid, even private payers, and a large march toward what we refer to as the self-insured, where you have large patient populations inside of individual employers like Walmart, for example, who prefer to manage all their healthcare on their own. And so, they are their own payer. So, you have a whole new paradigm going on, and technology is just one aspect of this. And so, we kind of have approached the hospitals as maybe the anti-technology solution, if you will. I mean, we’re walking in there and what they’re used to is having a seven-figure price tag on their enterprise system and anywhere between one- and three-year implementation, and lots of customizations after that. Large amounts of training of thousands of people to do a rollout, only to realize that they get to the end of that and now it’s time for an upgrade because so much time has gone by.
So, the way we’ve launched this really was very strategic in that we didn’t want to go through the IT juggernaut inside of healthcare. We knew that we were going to be handling patient data, which is very sensitive, as you know, there are laws around HIPAA and protection. And so, we wanted to manage this whole thing in the cloud. And Mendix was actually a really good solution for this because we could stand up this entire solution really in just a couple of hours if the hospital gives us all the right information. They give us their vendor contracts, and they give us the pricing files, and the list of users we can stand this solution up in a day, and the second day just come in and train them. It’s really not very difficult to understand, it’s just a web browser. It works very similar to some of the other things that they use on a daily basis.
Then the whole thing is self-contained in the cloud with all the security, and all the application layers, and all of the support that Mendix can provide to us to keep the system up and running with a very, very aggressive service level agreement that we can offer to the hospitals. And so, all of that together has really kind of been a breath of fresh air to the hospitals who when they see us coming and they hear software, they kind of hunker down and they’re ready for the worst-case scenario. But when we tell them how we do this, they’re actually very refreshed. And we’ll go through any security audit, we’ll do all the HIPAA compliance stuff that they wish for us to do, but in the end, we don’t have to go behind the firewall, which has been a huge advantage for us to get this out into the marketplace very, very quickly, and actually went over some customers and make them quite happy with us.
/ Mark Manning /
Is it fair to say, and perhaps I’m editorializing here, but maybe it’s less about the technology choices that are made in a project that digitizes a process, but more keeping your eyes focused on making it a simple onboarding process and less intimidating, is that correct?
/ Rich Palarea /
Well, yeah, I don’t think you’re editorializing at all in that, and you’re astute in the way you’re thinking about it. You’ve got lots of different interests, you could read that as political if you wish, inside of the hospital, some of which really don’t want us to expose a lot of what’s going on and has been for a long period of time. You take the Sunshine Act, for example, and you’ve got a website now out there in the public domain where you can go search the name of your surgeon, who is getting ready to perform a surgery on you, and learn in just a matter of seconds, how much money they’re earning from the implant companies. And that can be surprising, and in some cases, it could be more than they’re earning from surgery. And these kinds of things are for inventions that they have, patents, speaking engagements, other royalties that they get from helping the implant companies, and so you certainly have some conflicts of interest.
When you think about this, we deploy the solution. We like to think of this as a technology-enabled service. I mean, to think of us as a software platform really isn’t correct because what we’ve done is we’ve harnessed all of the power of low-code to bring an idea that we had, which is really a consulting service, to life inside of our application in a very quick way. And to be able to kind of democratize the way in which the knowledge has been kind of hoarded over a long period of time in these hospitals in different silos, but also with their suppliers who keep it from them, or they might share it, the supplier might share it with the surgeon, but the surgeon might not share it with the hospital.
We’re just bringing a lot of transparency to that, and yes, it happens to be technology, but the solution is really a people-centric solution. It’s one in which we’re trying to take the tribal knowledge that we have, and then quickly disseminate that in a way where we don’t have to be on planes and be physically inside of hospitals, which amidst what’s going on with COVID today, is a pretty difficult proposition. But fortunately, we haven’t missed a beat because our solution actually lends itself very well to that.
/ Mark Manning /
And it sounds as if, at least there there’s quite a bit of inertia behind the way that each of these parties are working. That the medical device company has its preferred way of doing business, that surgeons have their preferred way of interacting with their partners, and that CFOs and supply chain folks have their preferred way of driving transparency, and cost savings, and everything. Those are pretty divergent. How do you think about aligning those interests? How do you think about managing change in an organization when you’re bringing software and consulting to bear that’s, quite frankly, disruptive to each of those parties?
/ Rich Palarea /
It is disruptive. People ask me, especially growth partners who are interested in placing an investment here, “how are you guys going to go to market? What are you planning on doing as it pertains to making the introduction to this idea and then all the way through the sales cycle?” And I think frankly, the people outside of healthcare are shocked to learn about the length of our sales cycles, which can be lengthy. And like I said, it’s basically because there are so many different stakeholders in this transaction to consider and everybody needs to be considered. And everybody’s workflow is extremely important, especially what’s going on down in the operating room. We don’t want to disrupt any of that while we do have a quote, “disruptive,” technology here.
We’re trying to actually honor all of those stakeholders, they all play an important role, and also honor the existing workflows, some of which the adoption of low-code here has been quite instrumental for us in, basically what we’re doing is we’re mirroring broken workflows inside a hospital so that we don’t have to change anything and we can get up and running very quickly. And then it’s only months later where the hospital would say, “we’ve noticed that we’re putting things duplicative, they’re in two different databases and we’re doing the same work. Can we just do an integration?” And we would tell them, if we would have told them from the day we implemented that that integration was possible, then we would still be in the bottleneck of IT trying to get started. So, we typically will use low-code because we can mirror these broken workflows very quickly and get up and running very quickly.
/ Mark Manning /
Pulling on that thread a little bit, what sort of insights can a hospital system expect to find as a result of all of this data and all of these inputs being daylighted essentially?
/ Rich Palarea /
I think there are a couple of way points along the way. If you think about this kind of a maturity curve, where you start with the first thing a CFO in a hospital will tell us is, “I just need to save money. You’re going to tell me that my pricing is out of whack, and there’s a couple million dollars here kind of sitting here on my watch. Yes, I’m perfectly happy with sharing that with you. I’ll give you a small portion of that percentage, if you can go out and find it for me.” And so, we’re happy to do that. We don’t expect them to really understand and grasp the true spend management approach of the category right off the bat. They just want the cost reduction. But ironically, what happens in most hospitals is the CFO, and the surgeons, and the supply chain will come together in this kind of collaborative project and try to get these costs down, and they will actually succeed.
There really is not a problem with hospitals doing this on their own, they’re pretty good at it. They will kind of throw their weight around and muscle that cost down and they’ll get some savings. Almost to the moment, and the ink is not even dry yet on the contract, to the moment that new pricing goes into play, those vendors are already scheming on how they’re going to kind of win back that margin. And so the spend management part of this is really important for a hospital to understand that they can’t just walk away from the table because they got themselves 10 or 15% of their total annual spend, which can be tens of millions of dollars in these categories, and high five, right? And walk out of the room and turn their back on what’s going on down in the operating room itself, and that workflow. And that broken workflow where a piece of paper is being used in the operating room to track all of these implants, and then a sales person standing in there uses a pen or a pencil to scribble down the price and walk that piece of paper down the hallway to purchasing and turn it in expecting to get a purchase order, that has to change.
And so, when you start to collect this data, you can begin to illuminate all kinds of really interesting things going on. I’ll give you just kind of a basic spectrum, at the lowest end everything that’s going on that piece of paper that isn’t getting captured, because that piece of paper turns into a requisition, which then turns into a purchase order, which then goes back to the implant company, and an invoice is created against that PO, and then that invoices is sent into accounts payable at the hospital. That’s the typical purchasing workflow that exists today. Largely paper-based in the beginning, it moves into an electronic transaction later on in the workflow. And we’re still using things like EDI, if you can imagine that.
So, there’s a lot of antiquated technologies inside of the hospital as well. To be able to see very quickly to unlock that paper and capture all that utilization in an electronic format that can quickly adjudicate without taking coffee breaks, or taking vacation, or anything, Kermit doesn’t need to sleep and it doesn’t need to be fed, it just works. And you can adjudicate what is inside, locked inside of that contract, that you spent so much time as a hospital VP of Supply Chain negotiating with your vendors that you’re not going to pay for a drill bit whenever it’s used on a hip case.
Well, that’s a great term, but how are you actually going to police that? Or you’re willing to take the price that you’re trying to negotiate, you’re willing to take a rebate instead of getting kind of that price on paper, you’re willing to take a rebate over a period of time in order to get that price where it needs to be. But you’re not exactly sure during the month, or during the quarter, or even annually, how many of those implants you used and how much of that rebate is coming back. You can’t budget from it, you can’t forecast. And then you’re having a report coming back from the very company that’s paying you the rebate is giving you the report about how much you used. Something’s wrong with this picture, so we have to advocate for ourselves. We, meaning the hospital environment. We have to be able to track this information so that we keep everybody accountable and there should be transparency.
So more than just the audit, kind of at the other extreme of that, we have hospitals that will tell us they manage their surgeons, say five or six surgeons within a hospital, they manage them really well, and the surgeons collaborate nicely, and they even talk how one surgeon is on the leaderboard for saving money this month, etc. What hospitals are having a very difficult time doing, is those hospitals that run a health system, meaning a health system comprised of more than one hospital, they’re having trouble comparing a cohort of surgeons across the multi-site environment. They might manage a group of surgeons who are performing spine surgery really well in one location, but if those surgeons aren’t sharing those wins about the kinds of things they’re doing to help their hospitals keep the costs down, or the type of innovation they’re doing to ensure that a patient is having a great outcome, then the health system really is suffering, and so there’s the patient population.
One of the things Kermit can do very quickly through our analytic dashboard is be able to compare the cost of, let’s take for example, a one level interior cervical fusion. I know I might be getting a little bit technical for the listener, but this would be a pretty standard spine procedure that’s done many, many times on any day in the United States. And in order to affect the outcome that we want for that patient, there could be lots of different constructs, or different combinations of spinal implants, that a surgeon could use to get to the same outcome. One surgeon might like a particular system that’s comprised of three parts, while another surgeon prefers a system that has 15 parts and lots of different adjustments and things that they can do for that patient. Well, those different solutions have wildly varying price points.
And so when we start to get this visibility about what’s going on with the surgical cohort, if you can think about maybe 15 surgeons, spine surgeons, across three hospitals, and they’re all able to compare how they’re treating this one particular disease state for the patient population, we can now begin to see very clearly the spectrum of the low cost surgeon and the high cost surgeon. And by tracking the outcome of the patient, did they have a good outcome? We can find the intersection between getting that price down as low as we possibly can, and a patient that still has a fantastic outcome. And this is really the mantra behind, you may have heard of bundled payments. This is where Medicare wants to take all of healthcare reimbursement. And they’ve started to do this in a very conservative way, at least inside of knee and hip surgery, that’s already underway. And this is the law of the land now, so there are a number of hospitals that are mandated to participate in a bundled payment, which just means simply that the hospital’s going to get one fixed payment for that episode of care.
And now it’s up to the hospital to manage their own costs, right? Basically, we’re asking a hospital to operate like every other business in the United States. You manage your costs and you manage your profitability. And Medicare is basically saying, if you come in with this window of the fixed price, we’ll actually let you keep the upside. And so, it’s a good deal for those who can figure out where is the data? Am I really profitable? And how do I kind of leverage this program and participate in it in a meaningful way, rather than we go in because we’re mandated, and we kind of get it handed to us in the end because we don’t know how to manage our costs, because frankly we can’t see them. And so that’s what we’re trying to do with our analytics and our comparative reporting that we provide.
/ Mark Manning /
And it sounds like so there’s buy-in, Kermit is onboarded, there’s cost reduction achieved, there is spend management achieve, there’s some interesting overlaps between patient outcomes, and the cost of the materials that went into it. There’s also an interesting opportunity for your team with that wealth of data and the possible outcomes there. What do you folks have in mind for enhancing your product or finding new use cases for it?
/ Rich Palarea /
We started with this kernel of an idea that said, if we could just reduce the cost, we could really provide a valuable service, not only for the hospital, frankly, for patients, for this just bloated system that we have in healthcare, where everybody’s got their hand out for a dollar. And in the end, the person who suffers the most probably is a patient who is overpaying for these services. And where this has kind of blossomed to is a lot of information that we actually have access to in the surgical case. And so starting nine years ago, when we launched the software, we really didn’t know why we would collect some of this data, we just knew that if we could get our hands on it, we would hold onto it long enough to then understand where it might be valuable.
And so, one of the interesting things that, I wouldn’t say we’ve stumbled upon it, because I think we all know about product recall. We know about, there are plenty of different recalls that come out of the FDA, but in implantable medical devices in particular, there’s a pretty robust stream of recalls going on. And so, we started collecting the lot number of the implant pretty early on, and we just kind of tucked it away. And it wasn’t until recently, really with what happened with all of coronavirus kind of stopping all of the elective surgeries at our various client locations, that we said, is there another thing we could be doing that would be valuable for, something we could monetize, but also something we can do for the patient population?
And we went back and looked at this kind of FDA recall module, we don’t even have a name for it really inside of Kermit, that listens to the FDA feed that’s being published daily for implantable medical devices that are being recalled. We can parse that data in real time, and we can tell a hospital, not only, “You have a product that has been recalled.” Before you’re going to hear about it from the manufacturer, likely before you’re going to hear about it from the FDA, because neither of those parties do a very good job of notifying the hospital. But what a hospital really fears is that they’re going to hear about this from a litigation source, from an attorney, or even worse from a commercial advertisement that’s on TV. And so, they would like from a risk management standpoint to get ahead of this.
We can parse that feed, we can sift through the lot numbers, and usually these recalls come out as a range of lot numbers. And we can tell a hospital right when that fee comes out, we can publish an alert to them in Kermit that they have this implant inside of a number of patients, we can tell them exactly the patient name, the date of surgery, who the surgeon was, and even start them on their way with the paperwork that they need to file. And so, when elective surgery started to slow down, we were wondering how we we’re going to kind of keep the business afloat. We looked at providing this kind of information directly to the public, and so we’ve launched another effort here, kind of it’s in the skunkworks phase, if you will, but it has a lot of promise and it kind of goes like this:
If you’re a patient that’s had a medical device implanted, or you’re thinking about having surgery, you can actually take that information, go to a website and feed that information to the website, and for a very small annual fee we’ll just kind of babysit that information. We’ll monitor it, and we will alert you if there’s a recall that needs your attention. And a lot of these recalls, they’re not life-threatening, there have been some that have been life threatening, there have even been some that have come through the Kermit application that we’ve found that have been life threatening, but the majority of them don’t require immediate action. They’re not life threatening. And a lot of times hospitals just won’t even tell the patient that there’s something wrong. And so, we can tell the patient directly and they can take it up with their physician about how the hospital, or the surgeon, or whatnot is going to remedy that.
We’ve already had some early interest from insurance companies that are, they’re positing that they’ve already paid for one surgery and if that surgery had a failed implant, they’re paying again for that remediation, they’ve paid for that twice. And you would never do that if you bought a TV from Best Buy and it went bad and Sony was going to honor that warranty, you’d just take the TV back to Best Buy and get a replacement, you wouldn’t pay for the second one. But that’s what’s going on inside of healthcare because nobody really tracks this information. So that’s been fun to kind of watch, nine years into this, watch my team really get excited about almost a brand new company that just kind of birthed out of a very difficult time, not just for our organization, but really for the nation and the world going through this whole virus and this pandemic.
/ Mark Manning /
It’s a testament to sort of to what’s possible, that even if a project like this begins with a very defined outcome with the data, that just by merely having it digitized, that there are a wealth of interesting possibilities at the end of it.
/ Rich Palarea /
Right. I think you’re right about that. You can think of lots of really fun, cool opportunities that exist like this. It’s a matter of just sitting down and doing it, right? You just do it. You got to sit down and figure out if we can just kind of stick our hand in this really messy workflow and just change one little piece of it, let’s try, let’s just see what comes of it. And I think in the case of where we were, we were very fortunate to start with a couple of customers who said, “Look, I know this is brand new. We don’t really have anything to compare it to, so I don’t know how successful you guys are really going to be with this, but we trust you enough. And you guys seem fairly competent that yes, you can use our real patients and our real data and go ahead and kind of build it in our midst and let’s just see what comes out of it.” And that had been fantastic.
I think a lot of technology solutions, as they say in the venture capital space, are a solution looking for a problem, so to speak. And I think if you are fortunate enough to work with really good customers, or you have a nice marketplace, where experimentation is looked on as innovation and there’s low risk in doing that, that you can create something in a very, very short period of time with a very small development staff. In the case of Kermit, we brought this to market with one developer in nine months at a very, very small budget, which would have taken us a considerable larger effort to do. And then be able to trial things, and then be able to iterate very quickly and even do, if you want to, nightly releases of your product, that’s entirely possible with the way that a low-code environment works.
And that wasn’t really possible when I was doing this 10, 15, 20 years ago, leading teams in a traditional stack. It just wasn’t possible to work in an agile methodology and iterate very, very quickly. And that’s what’s been really fun about this. We even joke that, we have two Mendix developers on staff and we meet for a weekly software sprint every Friday, it runs from 10:00 to 11:30 AM. And we hesitate coming up with problems in that meeting because typically what they will do is they’ll get really quiet and kind of check out. And within a half hour they’ll report back, just sitting at the table, they’ve already solved the problem and they’re ready to make a release to the test environment. It’s actually something that you can bring a solution very quickly into life, and you’ve got to be actually really disciplined about how you do your software development so that you can guide people and give them the right things to work on at the right time, so that they’re just not distracted because the tool is very flexible, to be able to do something like that.
/ Mark Manning /
Rich, it’s a fascinating story. And I think I can speak for all of us when I say that we’re looking forward to seeing what’s next. I think that concludes what we were hoping to talk about today, but thank you very, very much for your time on this.
/ Rich Palarea /
It’s been my pleasure. Thank you.
/ Mark Manning /
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