In the latest episode of the Futurum Tech Podcast, The Interview Series, Daniel Newman welcomes Dr. George Mathew, who is an internal medicine physician and Chief Medical Officer for the Americas for DXC Technology. He also welcomes Paul Thompson, Vice President of Global Healthcare Strategy and Product Development for DXC Technology. In this podcast episode, the two talked to Dan about the current state of price transparency in the medical field—and how technology can improve this issue.
First, they agreed on the fact that most patients don’t think about what the real cost of a procedure or office visit is. They think about their copay, not what insurers are charged, meaning they’re insulated from the true cost of healthcare. Dan mentioned that people want to know more, kind of, but mostly they want to pay less!
Currently, healthcare is about people paying insurance premiums and copays and then not worrying about it. But lately, large employers are pushing larger insurance costs onto their employees, and it’s becoming a problem that people are more worried about. They’re starting to demand price transparency, which starts with better communication of what services are being rendered, and what people are paying for.
When Dan asked how providers are addressing transparency in healthcare today, and how technology can help this, George replied with his experience working with commercial health plans. At that time, the work was focused on increasing the efficiency of providers, information that was delivered through an online provider directory that allowed them to share a lot of information. They tried to offer the ability to search for the cost of procedures in a certain area but found the price could range a lot. Though they were able to find doctors with better efficiency and lower mortality rates than others this way, the data they had was raw and analytics capabilities were not as good as they are now.
George went on to explain how technology investments could enable better realization of efficiency. After all, hospitals have made huge investments in electronic health records due to government incentives in recent years. Providers (which are defined here as hospital systems and healthcare systems, which have been acquiring doctors and using them) found their systems needed to be connected together for better value. They needed an outside integrator to do this. Aetna even said 5-10% of healthcare happens in the doctor’s office or hospital, and the rest happens in the home.
So, it’s good to find ways to get data from smart homes and apps on your phone, creating a 360 view for a better patient experience. But part of the patient experience is price. You don’t want to be shocked by the price after the procedure! At the same time, not all procedures are the same, and this complexity makes it hard to say the price of each one.
Of course, technology will help with this ability to let patients know prices upfront. Healthcare technology can streamline systems and merge databases. But regulation and compliance are big hurdles. George explained that the most immediate driver is President Trump’s executive order around price transparency, which dictates that there will have to be price transparency given by providers and health plans so procedures can be shoppable. There’s not been a huge amount of work done at the state level yet compared to the federal level, but it will have to begin soon since consumers are starting to need it.
Overall, the gist of this podcast was that patients don’t care about overall price, but the cost to them and the outcome, such as whether they got better. They want value, which means they’re paying an affordable price for a good outcome. And the experts are starting to figure out what people are willing to pay for. With healthcare, they haven’t had enough data, especially providers, but now there is more in the last five years that can help put forth some good estimates. With better technology, we can help people see what they’re paying for, improve value, and enhance the patient experience.
Dan concluded that lots of work needs to be done, and systems need to go through more transformation before we can realize a digitally transformed healthcare system with price transparency. But that’s the goal! If you’re interested in learning more on price transparency in healthcare, listen to the full podcast today.
Daniel Newman: Welcome to the Futurum Tech Podcast. I’m Daniel Newman, your host today. I’m also the Founding Partner and Principal Analyst at Futurum Research. Today on this special partner edition with DXC, we have George Mathew, Dr. George Mathew, and Paul Thompson, and I’m excited to be talking about price transparency, healthcare, technology, and how these things are coming together in the search for greater and better patient experiences.
Before we jump into this podcast, I need to just do a little disclaimer. This show is for information and entertainment purposes only. While we are talking to executives from publicly traded companies, we are not in any way offering or soliciting investment advice.
George, I’m going to start with you. Welcome to the podcast. How are you today?
George Mathew: Doing well, Daniel. How are you doing?
Daniel Newman: I’m doing great. We’re going to tell everybody I did that on the first take. George, can you go ahead and introduce yourself to everybody and your work at DXC?
George Mathew: Sure. My name is Dr. George Mathew. I am an internal medicine physician. I’ve been working for about 20 years. I also serve as the Chief Medical Officer for the Americas for DXC Technology. We are an IT vendor that is in multiple industries. Healthcare is arguably our largest industry where we pull in probably a few billion dollars globally. My beat, if you will, is North and South America where at this point in time we cover about 42 States for Medicaid claims processing, along with hospitals, insurance companies, and life sciences companies. We do the IT portion of just about everything. We’re the biggest company you probably have never heard of.
Daniel Newman: Oh, I’ve heard of you. Of course, I have.
George Mathew: Thank you Daniel. That’s the one guy.
Daniel Newman: No problem. By the way, what an interesting set of roles to, A, Dr. George Mathew, Internist and B, Chief Medical Officer for a big tech company that’s doing big tech integration. I can see why that would make so much sense.
Anyway, welcome to the show. Paul Thompson, we also are very excited to have you here. How are you doing today?
Paul Thompson: Pretty good, Daniel. Thanks for having me on.
Daniel Newman: Yeah, so Paul, same deal. Give us a little bit, give us the skinny. What is your role over at DXC?
Paul Thompson: I lead our product and service development for our commercial healthcare group, and that’s primarily focused on commercial health plans like your Aetna United, along with integrated delivery network. Those are hospital systems that may own a plan or a plan that has merged up with the hospital system. We’ll talk a little bit about that trend of convergence as we go. I also do a little bit of work in the hospital space as well. Areas that I’m very interested in right now are, as I mentioned, convergence, both of the payer and provider, but a more macro aspect is the convergence of healthcare, financial services, and the retail industry. That will go right to the heart of what we’re talking about with pricing transparency.
Daniel Newman: You, by the way, helped me get this show started Paul. Price transparency, because that’s really what I want to focus on with this episode. I want to kind of bridge together tech, I want to bridge together what’s going on in healthcare. Let’s talk about that. Let’s just start right there.
First of all, what does that even really mean? I think if you asked 10 average consumers of healthcare, what price transparency really means, you’d get 10 answers. Why is it now the time to start talking about it?
Paul Thompson: I think, great point Daniel, price to most people when they think about their insurance coverage is their copay or their deductible. When you talk to them about the price of a doctor’s visit, they’ll tell you it’s $10, or if they have a high deductible plan, they might say, oh, it’s $60. What they’re really not sensitive to is, what the real cost of a procedure is or an office visit with some services that’s incurred, when those services are provided, billed to their insurer, for which they’re responsible for only a little piece of it.
When it comes to price transparency, people have been insulated from the true cost of healthcare for a very, very long time, and like any economic good, if you don’t know what the price of it is, it’s difficult to value and it’s difficult to make choices around.
Daniel Newman: Yeah, I think that’s really an interesting point though, is transparency, you hear a lot of it and you know, we’re in the middle of an election cycle, this is obviously going to be a sensitive topic for many as we’ve seen the healthcare climate change drastically over the past few years. People want to know more, kind of, about it, but really I think what people want is to pay less, I think is really what most people are saying. What you’re saying is that people don’t really seem to understand what they’re buying and what they’re paying for. And so part of price transparency starts with maybe better communication of what services are actually being rendered. Probably also thinking about what are you paying as a whole, that entire hospital, that healthcare facility, when you go to a hotel, you understand that you’re not just paying for that one physical room, you’re paying for staff, you’re paying for the lobby, you’re paying for the maids and those that make up the rooms. You know what I mean?
But in a healthcare, it seems like people can’t get past the fact they’re only paying for whatever single service that’s being rendered for oneself.
George Mathew: That’s a fair point. Daniel. When you think about it, our buying in healthcare traditionally has never been a direct, I buy this thing and I get this thing, unless you’re talking about plastic surgery or something else that’s basically over the counter or direct kind of payment model.
For the most part it’s always been a, I pay my insurance, it covers things, I don’t worry about it as long as I pay my premiums on time. I think, to Paul’s point, that slowly has changed over the last couple of years, where now employers, large insurance companies are pushing more of that cost on to patients to pay for themselves, now it’s becoming a problem because do I get healthcare, or do I pay my rent, or do I eat?
Daniel Newman: That’s a question that I don’t think people should often have to ask. That’s also a statement that’s so much larger than myself.
Let me ask you guys the next question though, because you talked about what transparency looks like, you talked about what it is, and we debated a little bit here how it’s interpreted and how people see it, but how are the payers and providers addressing transparency in healthcare today, and where can technology help this? If I can just add a little bit of color to that on the front end is, are they addressing this today? Because I think the average consumer would say it’s not happening, but you guys as insiders probably can shed a little light on that.
Paul Thompson: From that perspective, Daniel, prior to joining DXC, I worked in two very large commercial health plans for a very long time. One of my roles there was around the early stages of cost and quality transparency efforts. I’m going to interdict by the way, as we go I’m going to mention quality a lot because I want to make sure that we make that connection before we leave today. The work was primarily done around measuring the efficiency of a provider and delivering care, and we’ll talk a little bit hopefully more about efficiency versus price as we go here, but it was primarily delivered in information through an online provider directory and that was one of the great selling points around an online provider directory versus print. You could do a lot of dynamic information provided to people with it, and we endeavored in the industry and it wasn’t just the plan that I worked for in particular, but a number of plans would put into their provider directory the ability to search for the cost of a procedure with an area, and it was a lot of variation. It was a huge amount of variation.
One example I point to is, we’re looking at the cost of a colonoscopy in the San Francisco Bay area, and it ranged from as low at the time as $400 up to $1,650 on a same procedure basis. That variation existed and we published that, and people became sensitive to it. It was still early in the high deductible consumer driven plan years, so it was more an awareness factor for people as opposed to a true shop-for-care experience. It was difficult and challenging to do. The data was very raw. The analytics capabilities weren’t where they are today. We had to do a lot of manual work and manual intervention, which was limiting to the work that we did.
I will say though, from a value perspective, we looked at 21 physician specialties, and those 21 physicians specialties influenced or touched around 80, 85% of the overall cost of the care. We were able to find physicians that were delivering care 33% more efficiently than their peer group and lower complication rates. We applied the same algorithms into the hospital space. We were able to find hospitals relative to their peer group that delivered care 30% more efficiently, or less expensively, but more importantly, with 28% lower mortality rates and saving money is exciting, but living is a lot more of an attention getter when it comes to looking at those statistics for a member.
Daniel Newman: Absolutely. I mentioned in my question and you alluded to it through some of this data that tech has clearly played a role in being able to help improve transparency, but you guys are actually really involved in integrating this stuff. What do those technology investments look like? What are the tech that… We’re seeing healthcare systems, providers, insurers really get into that are going to enable this greater realization of efficiency, delivery of better service to consumers, all the while obviously still continuing to build value for these companies and their shareholders.
George Mathew: It’s George. I can comment a little bit on some of the provider’s side as to what they’re looking at for investments. Hospitals as you know, have made a huge investment in electronic health records over the last 10, 15 years because they got government incentives to get those things implemented in. They’re very good at doing billing, coding, and scheduling for inpatient service. You go to the hospital or doctor’s office, you see a doctor or a nurse, they put the information into the system and it collects it, holds it, bills against it, that type of thing. What we found though is, a lot of our provider clients, and let me define provider to be fair. Before people would have thought of providers as being doctors or nurses or healthcare professionals. In the corporatization of medicine, hospital systems and healthcare systems have become the big entity, and they are acquiring doctors as part of them. I just want to make sure I’m clear on that definition as I’m using it.
For these hospital systems, these providers, what they found is, other systems like their HR systems or their service IT, their radiology systems, all these systems need to be connected together to really get that value. What we’re seeing is they’re trying to find ways to pull that together in. Some of that can be done with their existing electronic health record, especially if it’s big enough, but for some of these providers, they need an outside integrator to fix that. That’s inside the hospital. Let’s say the four walls of the hospital system.
To get the true value and get that consumer experience, that retail health experience, they need to go outside the hospital and get the data that happens outside of there. I think it was Aetna actually that quoted that five to 10% of healthcare actually happens in a doctor’s office or in a hospital. The other 90 to 95% happens in the home. Creating those connections where you can get data from smart homes, from apps on your phone, from [inaudible 00:11:46], in terms of health. Being able to pull all that outside data in and create a full 360 view, that’s where the investment dollars are going, to create that better patient experience.
Part of experience, which I think you mentioned is price. Last thing you want to do is take a great vacation and get a huge price check at the very end for stuff you didn’t expect to pay for it.
Daniel Newman: That’s an interesting parallel because I think it’s even worse if you take a relatively bad or even good experience at a hospital. That’s like being surprised at the dentist. Oh, thanks for the root canal. It’s going to be twice what you expected. Oh, that’s terrific.
George Mathew: Oh, and Daniel, I took out all your teeth while I was at it. I hope you don’t mind.
Daniel Newman: Only if you put in those shiny Hollywood veneers that everybody… Because that would actually make me look like everyone else. But no, actually it’s really interesting. But you know, by the way, I don’t think we don’t have time to talk too much about this, but I do hear this a lot. Maybe just a quick comment, Dr. Mathew or Paul on this one, but the dental industry is one of those where people tend to really talk about, why is it so transparent? I mentioned that, made me think like, is it really this hard? Is it really as hard as it’s been made? Like I said, in a quick response, do either of you want to take that one?
Paul Thompson: Sure. I’ll take that one, Daniel. Not being a dentist or a doctor, I’ll look at it from a layman’s perspective. If you consider dental versus medical and I’ll bridge what George said to this, you have what, 32 teeth, there’s five surfaces in a root, and it’s extremely predictable what the dentist is going to do to you. If you go in for your cleaning, they may discover a cavity. You go back to have that cavity filled? It’s a pretty straightforward transaction.
When you look at what we term a procedure, with quotes around it, say colonoscopy, you and I may call it a colonoscopy, but once it’s in the exam room, it becomes a colonoscopy with anesthesia, without anesthesia, with excision of polyps. George weigh-in on additional clinical procedures that may occur.
George Mathew: Sure.
Paul Thompson: But one procedure is going to be very different from another for what we term the same thing. So there’s a complexity Daniel to medical versus dental. Very, very different, and that’s one of the things that drives the difficulty of this.
George mentioned the work that the providers are doing within their four walls. When it comes to bringing transparency into the healthcare venue, what the payers are striving to do, or the health plans are striving to do, is interface with those providers to share information or combine information, because the health plan has a longitudinal view of what happened.
You may see three or four different providers in the space of getting a knee replacement. Each one of those providers may or may not be affiliated with the same hospital system, but now information is [inaudible] in three or four different EMR. Those electronic medical records don’t speak to each other. The payers are trying to bring that information together, combine it with their claims information, and apply analytics to it to spot patterns that are influencing the cost of care. I just took it from the simplicity of dental to the complexity of medical, and what the technology being brought to bear to solve that problem is.
Daniel Newman: I think that’s a great explanation. I tell you, I don’t think patients care, but at the same time I think that’s where tech can really shine as it starts to kind of help streamline, bring these systems together, merge databases. Of course regulation, compliance is a huge hurdle. That’s part of what’s slowing… But also I guess potentially moving some of these providers and networks forward is what’s required of them. Talk a little bit about that, what is the state with government regulation around price transparency? What is coming down the pike in the near future?
Paul Thompson: The most immediate driver is, again, we mentioned earlier this trend has been going on in the health tech community for awhile, president Trump’s executive order around price transparency, both for pharmacy which was challenged in the courts, and now medical transparency, dictates that there is going to be price transparency provided by both the provider community, as well as health plans around a set number of procedures that they have deemed as being shoppable. That’s the primary driver and there’s also some legislation moving along within the Senate similar to that driving requirements on transparency.
There hasn’t been a huge amount of work done at the state level yet. They’ve been looking to build all payer claim databases to try and do analytics on it and discover those patterns on their own but they have not really been as compulsatory as that executive order and the trend that some of the legislation at the federal level is going at. The writing’s on the wall, both on the fact that it’s already started, consumers are starting to need it in order to manage their plans, and then ultimately at the federal level it’s driving it, which tends to trickle down to the state level over time.
George Mathew: The response has been tepid, I would say at best Daniel. For the providers, when the original mandate came through for them to have price transparency and put it up on a website, most of them either put a broken link up or they would put a spreadsheet with 15 or 20 procedures with all the same price listed. Some of them don’t really know and haven’t put the time into actually doing it because the way they generate prices, it’s the way it’s been 40 years. It’s a spreadsheet in a locked office that they have all their pricing in, and they haven’t made a movement yet. Now the pressure is still there as Paul said, but even CMS, when they were asked about, look, people are reacting this way. What are you going to do about it? They kind of said, well, it’s unenforceable right now. We are going to keep pushing forward and try to get there.
Daniel Newman: As we’ve talked about offline, this doesn’t just affect the service providers or the healthcare providers and networks, it also affects the health plans and insurers. There’s got to be implications and I assume if the providers aren’t doing anything the health care insurers can’t really do anything either.
Paul Thompson: Well, yes and no. The challenge is, don’t forget, one of the premier value propositions that a health plan has is they negotiate rates with the providers that they pass those discounts on to the members. A couple of comments around that.
First is, that’s a great value and service that those plans provide, but it’s also a competitive piece of intelligence, so they don’t want to expose those rates too easily. You need to apply technology to find patterns and ways of making that information useful without compromising your position, and at the same time you also run the risk if those rates are disclosed, I call them the raw rates, and there’s some fear of this and I don’t know whether it’s founded or not, I don’t know if a lot of analytics has been done around this, but as you’d expect the contracted rates between physicians and the plans differ by hospital system and by provider group. There’s some fear that if those rates were exposed, that the physicians will say, well, I want those higher rates over there that you’re giving to my competitor up the street. You have, what economics call it, unintended consequences that may be there.
You raised a good point though when you said, the consumer, who cares earlier. You’re absolutely right. They don’t care about price. What they care about is the outcome of the services they’re getting. Did I get better? Did I not? Was it a good experience? And they care about the cost, not price, but cost. The challenge would cost is, as I mentioned earlier, when were talking with George about the procedures, it’s terribly difficult to bundle all the services that go together to a procedure, make it meaningful, but then more importantly, you then have to figure out what’s the deductible and where are they in their out-of-pocket and their annual maxes and all of the insurance benefit information that goes around that to make it meaningful to them.
I think that’s where technology will be really be brought to bear, is to help people understand where they’ve got the best outcome, at the best cost, and ultimately that gets to the value.
George Mathew: I think it’s an important point, because I was going to point out the quality or value piece of it as well. We talk price in terms of what people pay versus the cost. It really costs the person creating the product or service to put it together, but when you’re really talking about it, you really want value. You don’t want to pay a cut rate guy in a mall that doesn’t have a degree doing something on your body and find out later, well, okay, I’m missing a kidney and maybe half of my teeth. The price might’ve been low and the cost might’ve been lower, not a lot of value for you. If you get somebody that’s doing a good job, which is what some of the payers as well as the providers are trying to do now, evaluate which providers are doing a good job at an affordable cost, that’s value. And really that’s what the discussion needs to be. We just need to build up to that point.
Daniel Newman: You know, it’s interesting, I’m listening to everything you guys are saying and by the way, it’s super helpful. I think something a lot of people don’t realize, and I think about this even in my own healthcare decisions, is most people, like citizens or consumers of health, really aren’t qualified on anything scientifically to make a decision of value. Essentially Dr. Mathew, you might be a wonderful internist, but you may be the 1300 best out of 10,000.
When you go and buy a vehicle, you could say, hey, I know a Mercedes Benz is a premium product to a Kia. The point is, both do the same thing. They both essentially turn on, drive, play the radio, connect your iPhone, whatever it is, but there is a difference of value and quality. Because it’s a combination of the quality of service and the actual outcome, the happiness, the recovery, the net promoter scores, all those things are tied together, and people in healthcare really aren’t qualified in many cases to actually say, this doctor should operate on my knee, not that doctor because this doctor, I’m going to get more value.
By the way, just because I know you guys probably have something to say here, but the healthcare providers probably shouldn’t pay the same for the doctor that’s the number one in their field and has the highest demand and highest outcomes versus the number 1000. I know there’s always that joke, what do you call the person that finished last in their med school class?
George Mathew: Doctor.
Daniel Newman: Right. I know that joke, but when it comes to value, there are Pintos and there are Ferrari’s, and not all things are the same, just because everybody went to med school.
George Mathew: Well, but I think that’s in some ways, when we start talking about transparency and we’re talking about the addition of data and technology with healthcare, we’re starting to tease out what people are willing to pay for, what they want. The example you gave is a Pinto versus a Ferrari. When you walk into the showroom, you know what you’re there to buy it. It’s not a ta-da, black box. And here’s what you get. You’re not going to the Price is Right. You know exactly what you want. You have an idea of what the price should be, and you’re willing to pay about that price when you walk in.
Healthcare hasn’t been like that, only because we’ve not had a large enough data at least up until the last what, five or 10 years really. Payers may have had the most of the data, providers really didn’t. Now there’s enough data out there. People are starting to put together pretty good guesses and estimates. But ultimately what’s going to differentiate is that human touch, I think. Are you willing to pay that extra for that human touch? Because we’re automating everything right now, healthcare included. That’s what’s going to be offered to people that make a decision on, do you want that white glove, that human touch approach? Or are you okay with doing something digitally on your phone with Bot?
Paul Thompson: I think making that bridge to for you Daniel, we were talking about the technology element that’s important here. George made the point that it’s only been in the last five years really, that we’ve got large, large amounts of data. When I was doing this work, which was seven or eight years ago, if I looked at a community of cardiologists within a given marketplace, I could really only say something meaningfully different about the top quarter of the class statistically. If there’s 500 physicians, you can’t say something meaningfully different between number 378 and number 400.
Now with the analytics capabilities that are available, particularly when you enable it with cloud capability where you can move large amounts of data, you can do it cost effectively, and you can do it between organizations, you now bring measurement to bear against the problem that you mentioned. That difference between what the doctor knows and what you know, that’s information asymmetry.
When that occurs, that’s where pricing and costs gets out of whack. If you can start to measure performance, and we moved away from price a lot, we talked a lot about efficiency, there’s ways of statistically analyzing a physician’s practice pattern, and what we were able to find is physicians that do the same course of treatment much more efficiently than their peers do it. Some may order a CT scan right away while another will go with an X-ray. That saves money and gets the same result. We had physicians that were treating middle ear infections with eyedrops off-label, that were very effective in treating ear infections in children that were a fraction of the cost of the normal middle ear infection, pharmacy scripts.
There’s a lot that can be done with technology today against datasets that weren’t available as recently as five, six years ago.
Daniel Newman: Oh yeah, the proliferation of data is huge and gents, I got to keep us moving here. Running a little long, but fascinating topic. Let’s just take a minute before I get to that final question. All the discussion, whether it’s regulatory or just disclosure in general, your quick flash take. Is it going to help people make better care decisions?
George Mathew: This is George. I’m saying yes. As information becomes more readily available, and more importantly as patients start sharing their experiences as to what worked and what didn’t, which some platforms do already now, you are going to see this movement towards, okay, now I have a better sense of what I’m paying for, and this is what I’m willing to pay.
Paul Thompson: I would second George’s opinion there wholeheartedly. What the plans are going to be able to do is give people the tools to have that better dialogue with their physician so that they can close that gap between what they know and what their physician knows. The way I said that doesn’t mean that there’s anything the physician knows more, it’s simply the way it is because it’s science. If those enabled consumers can talk to a doctor in a better fashion, I think it benefits everybody that’s involved.
Daniel Newman: Yeah, I think those are great answers. I think the parallel for me is that healthcare, like every industry that’s going through digital transformation has the opportunity to improve the way the organizations operate as well as deliver better customer experiences, or in this case patient experiences, through the utilization of technology while continuing to enhance and improve the quality of service.
What I’m hearing here from both of you, and by the way, terrific insights on this podcast is, I’m hearing that quality still matters. There is a value chain that is made up of the quality of service plus the price, much like whether you’re buying a car, a new mobile device, a computer, or a pair of jeans, it’s not entirely different. There’s a lot of complexities layered throughout the system that need a lot of work. There’s a lot of regulatory work, there’s a lot of systems work, and all of those things are going to have to go through a continued transformation themselves before we’re going to fully realize a digitally transformed healthcare system where price transparency truly exists.
Gentlemen, you’ve been fantastic. Thank you so much. Thank you for joining me here on the Futurum Tech Podcast. The interview was very, very valuable for everyone out there that’s listening to this podcast.
Hit that subscribe button. We’d love to have you join and listen regularly to these interviews with folks here like Dr. Mathew and Paul Thompson, and also our regular weekly episodes where we cover all the biggest topics in tech, diving in deep.
For Daniel Newman, Futurum Research, and the Futurum Tech Podcast, I have to sign off now, but we hope to see you very soon.
Disclaimer: The Futurum Tech Podcast is for information and entertainment purposes only. Over the course of this podcast, we may talk about companies that are publicly traded and we may even reference that fact and their equity share price, but please do not take anything that we say as a recommendation about what you should do with your investment dollars. We are not investment advisors and we do not ask that you treat us as such.
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