From Nonprofit to Profit: Mike Kotzen's Bold Move to Transform Home Care | Amivie CEO

0:00 Our [Music]
0:16 next guest says, "For most of my career, I worked in nonprofits, but when I looked around, I realized something
0:22 hard. The most vulnerable people in this country don't just need more missions. They need better business built to serve
0:27 them." Michael, I mean, what a strong statement to actually mention the first time that we actually get on after 25
0:32 years, man, in this nonprofit health systems. What made you step into the for-profit world and and and why why do
0:38 you felt that was just the change in need that was um you're looking for? Yeah, initially it was probably
0:44 different than than where it ended up. Um, you know, for me professionally, wanted to try something more
0:50 entrepreneurial, a little different. What I came to find out for this this world that I'm leading now is it it I'm
0:57 in a very fragmented industry, a lot of very small kind of mom and pop businesses. Um and really an opportunity
1:04 to hopefully professionalize the services that we can provide to vulnerable populations. Um scale, bring
1:10 technology to the forefront, um maybe a little more sophistication and partner with a lot of these small businesses to
1:16 kind of pull them together. And here we are eight eight years later and that's very much been been our story and it's
1:23 been com absolutely awesome. Listen, I'm a big believer there's something to learn from every part of
1:28 your life. What did you learn about um Philly's nonprofit world that still drives how you're even leading today
1:34 with the organization that you're running? Yeah, I think I think healthcare in general uh I've always really
1:40 appreciated a couple things. One, the mission around it, right? we all of any business associated with healthcare
1:46 ultimately exists to help people. Um, and that's always been something that's resonated with me. My my uh my mother
1:54 worked in in healthcare most of her career, so I got to see that a little bit. Um, but the other thing that I
1:59 really appreciate is the diversity of people that I get to interact with on a daily basis. So whether that was in the
2:05 hospital where it could be, you know, an orthopedic surgeon, a family who's
2:10 delivering their first baby, um you know, a single mom who's an employee of ours who happens to be working in, you
2:17 know, environmental services or a nurse, um and and all the families that come in at moments of excitement and joy, um but
2:24 also, you know, real times of need. So that that diversity of folks that I got to come in contact with and still do is
2:31 one of the most important things that drives me. Tell us a little bit about your organization. What are you doing currently today? A little bit about uh
2:38 where it got started, where you located for those that are listening and may not know. Sure. So, uh Amabe, we were formerly
2:43 known as Community Based Care. We were founded in 2015 and I started short shortly after that. The company was
2:50 initially founded with the premise of serving individuals in the state of North Carolina who have an intellectual
2:56 and developmental disability but to serve them in their home which and that's kind of become the story of our
3:03 company. We're looking to serve folks in their home to try to meet all their needs. So at that point we were um we
3:08 were serving that specific population in that specific market. We started off with about 300 individuals we were
3:14 serving. Um, and we have grown to we're now serving over 8,000 individuals,
3:20 employ about 8,000 folks across five states. Um, and largely doing the exact
3:27 same thing but for broader populations. So, we are we're the provider who provides that one-on-one support in the
3:33 home from everything from helping seniors age in place to seniors with a
3:38 physical disability to behavioral needs or intellectual and developmental disabilities. And and the thing that the
3:45 team does really really well is we've gotten really good at matching that the perfect caregiver with the client. Um,
3:52 and once we get that match made, we have we have clients we're serving for decades. Um, so these are all kind of
3:58 long-term relationships. You mentioned at home care. Why is home care both the most affordable and the
4:04 most human option and yet so overlooked? Well, I think it's becoming less overlooked literally every day uh
4:11 particularly as as budget pressures mount. Um, you know, we're a Medicaid Medicaid is basically our payer. So, we
4:18 serve primarily a Medicaid population. Um, and it's it's it's certainly the
4:23 least expensive venue of care. So, you know, we talk to our, you know, constituents all the time around we can
4:30 care for anywhere from 5 to 10 individuals at home for the same budget dollar from a state perspective that can
4:37 care for one in a hospital, a nursing home, a group home. Um, and you know, we
4:43 hear all the time, this is what families prefer. I mean, I I I too was a a customer of in home care with my father.
4:49 Um, needing someone to kind of be there when I couldn't. Um and and that peace
4:55 of mind that it provides families is um priceless, right? So um and and we're
5:01 working all the time around how do we continue to build our services to keep people in their homes where they want to
5:07 be. This is what you're doing today. Michael, did you always want to do this? Like what what was the vision that
5:12 Michael wanted to do as he was getting out of college or getting out of high school? Was it always to be in the
5:18 healthc care space or did he want to do something else? I would love to give you some like amazing inspirational story.
5:25 The the reality is when I graduated college, um I needed a job. I had some
5:30 good connections with a hospital system down the road. Um I I was working as a waiter and the owner of our restaurant
5:36 happened to be on the board. So he introduced me. I did a I did a summer internship right out of college
5:42 and completely fell in love with it for all the reasons I just mentioned. um just just you there's so many walks of
5:48 life that you interact with um you know from in the health in healthcare delivery and I'm an administrator. I
5:54 don't I'm not a clinician. I don't deliver care but I take a lot of pride in being able to give the folks that
6:01 work with us really rewarding careers hopefully recognize the amazing work they do because particularly in this
6:07 field you know our caregivers these are you know they're not in it for the money they're in it for the mission. Um, and
6:13 you know, and I'm really proud of of what our teams do. I was proud of it at the hospital. Um, and I get to go home
6:20 every day feeling like we did something good. And maybe I didn't put my hands on it directly, but um, you know, our reach
6:27 has been growing and growing with Amov. Um, but that's that's really been the thing that's that's been the most
6:32 rewarding over over my career. Um, and now I couldn't think of doing anything else. I mean, I love the story, right? you
6:39 you're working at you said as at a restaurant and the owner happened to be on the board like the way that life that
6:45 you explain that that's how usually happens. You just never know and and you tell your story, you tell people what it is you want to do and and people are
6:51 listening. That's why it's always um very important that you just not tell everybody your dream, but tell those
6:58 right people because they will open doors that you never even knew were available to you. And here you are today, man, years later.
7:04 100%. I I um if you would asked me then when I needed a job if I would be doing
7:10 this for 33 years I would have said there's no way because I you know at whatever 22 you don't know any
7:16 different. Um but honestly I couldn't think of doing anything else. And now man you're in the space of
7:21 scaling um this industry built by mom and pop operators. How do you preserve heart while still growing so many
7:27 locations? Yeah I mean I' I'd like to think we do it a little differently. Um, you know,
7:33 we we are we are a we consider ourselves a family of providers. That's how we've kind of built this company. Um, and
7:39 that, you know, that's all the legacy, you know, small family-owned businesses
7:45 that have come together. Um, and what I tell every owner when we have conversations about joining the family,
7:50 you know, someone looking to to sell their company, um, in addition to, you know, number one, we're going to do a
7:56 really good job. You know, we're we have a team of caregivers and support center staff that are entirely committed to
8:03 making sure we we provide the best service, highest quality um along the way. But I I talk to every seller about
8:10 like I I take very seriously the responsibility of carrying on their legacy cuz for a lot of these small
8:16 business owners, they they've gotten to the point where they've grown their business beyond what they ever expected.
8:22 Um, and typically they're faced with decisions like, do I invest in technology? Um, you know, how do I have
8:28 to look at employee benefits differently? Um, and these are personal decisions for them because they're they're a single owner. Um, so I take
8:35 very seriously that responsibility. You know, they've created this family of caregivers and clients that they serve, families that they support. Um, and
8:42 first and foremost, we want to continue that and and I'm really proud of the results that, you know, we have retained
8:48 through all those acquisitions well over 90% of their employees and caregivers in every single case. Um, and I love just,
8:55 you know, having as we're talking to different um, you know, potential partners to go talk to any of those 48.
9:01 Um, because, you know, the thing, one of the things that's really important to me and and hope, you know, I think this
9:06 filters down through the organization, we are who we are. We say what we're going to do. We don't we don't say
9:14 there's not going to be any change because that would be pretty naive. Um and hopefully we have a really good
9:19 track record of doing what we say and and telling them what we're going to do and that that goes a long way.
9:24 Yeah, man. You mentioned a lot of times owners asking themselves, do they invest into the right technology? Is there
9:30 technology that you felt that you've implemented that really help scale or is there anything on the horizon that you
9:36 feel could definitely continue to help move the needle that you guys are are um under right now? Yeah, I mean we in two in 2021 we were
9:45 at our own inflection point around we had we had as I mentioned we started with 300 clients. So we had technology
9:52 that could you know get us to the point of maybe 1500 clients or so and that's how that's how we measure growth. How
9:58 many people are we impacting and serving? Yeah. Uh and for us it was a decision you know
10:03 you know strategically how far do we want to grow and making sure that we have scalable systems that can get us
10:08 there. And those are really significant investments and we are still kind of growing into our shoes for for small
10:14 businesses. They're not typically going to consider the kinds of systems we are. Um but they're also really significant
10:21 investments. Um, and it takes talent around those investments to ensure that
10:26 you're optimally using the technology cuz anybody can buy a system off the shelf. Um, I think the last statistic I
10:33 saw, you know, most electronic health records are utilized 30 30% of what they're capable of doing. Um, you know,
10:40 so um, and in 2021 2022, we implemented every system we have in place now.
10:47 Um, we kind of slowed our growth to get get our footing under us. And that's a human human capital management system,
10:53 financial system, electronic health record, um, recruiting system, all of that is is pretty new to us.
11:00 I didn't hear you say anything about AI, Michael, we're in the space of AI. Are you guys seeing that that's worthy what
11:06 you guys are doing? Do you feel like it's not needed? I mean and I think about the side you talk about administration really on the
11:11 administration side um where we can do things more of the things that we like but we can automate and we can use AI to
11:16 do the things that we don't like the things that we didn't go to school for that doesn't interest us as much are you guys in that space
11:22 we are starting to explore opportunities for AI but but honestly we haven't implemented anything yet there and
11:28 there's a fair amount of application I think in our the services we provide um
11:33 you know a fair amount of what we do is very transactional in nature you know whether that's kind of the early stages
11:39 of recruiting, you know, filtering through 6,000 job applications or um you know, we have different authorization
11:45 service authorization processes across the different markets that we're in. Some of those things definitely have
11:51 application for AI. Um you know, where we've where we've used it kind of immediately is just in the way we
11:57 operate. We're a remote business. We have employees across 20 different states and you know using very simple AI
12:03 tools like Gemini notetaking um really goes a long way to to help keep people on the same page. But I do think there's
12:10 there's definitely opportunities for us um in the future, but we're just at the infancy of how we can utilize it with
12:16 with uh with our systems. I know you mentioned Medicaid a little earlier that you guys kind of um work
12:21 around this Medicaid model, but do you think that it's going to be impactful now with all the government cuts? like
12:27 are you feeling it now? Is that something that you guys even worried about? Um I'm kind of imagine that you already looked ahead at those type of
12:33 options. Yeah, I mean with with the the federal uh OBBBA
12:39 uh bill for for the services we provide, we there's not really any direct impacts
12:45 of that bill on the services we provide. That being said, where you know the
12:50 challenges that we expect we'll have to navigate in the future will come in is how it impacts state budgets. because
12:56 ultimately our services are funded state by state. So, um you know, we we look to
13:01 have a diversity of different markets so we're not kind of over overloaded in one particular state if something should go
13:07 should go the way we don't want it to. Um so, that's something I I'm sure will have at least a near-term impact as as
13:13 states try to figure out their own impact on kind of federal matching for for Medicaid. All that being said, I
13:19 mean the argument that we will continue to make and I think what um you know every state Medicaid office understands
13:25 and most legislators legislators understand we are still the lowest cost.
13:30 We are cost savings the you know the the the services we provide because we're still the lowest cost of care across the
13:38 continuum from home all the way up to institutions. Um, and you know, it
13:43 really enables us to continue the the message around, hey, if anything, continue to invest in these services for
13:50 the potential of long-term savings in some of those other settings. So, it's, you know, it it certainly creates some
13:56 noise now. Um, but but to be perfectly honest, there's always some level of noise when it comes to the regulatory or
14:03 reimbursement framework. Um, and we, you know, we try not to overreact to any one
14:09 of those things. If you know for this business and this is one of the things I appreciate most about what we're doing
14:14 at the end of the day if we take really good care of our clients are responsive to the the needs of the families and
14:20 take really good care of our employees. The rest of it honestly takes care of itself. Um and that's where we try to
14:26 keep our focus. Just listening to you and and the way that you navigate some of these um
14:32 questions, the way you respond to them. I could tell that you're just an amazing leader. Where does some of this leader leadership come from? Is it something
14:38 that was poured into you? Was it just life experiences? Like someone has to
14:43 pour into Michael, right? Where are you learning all this? Um I honestly I I just try to I try to
14:52 listen to every interaction I have. I try to watch um you know um people in
14:58 leadership roles. I've worked with with some really good and some really bad with with and for some really good and
15:04 really bad leaders. And I like to think um along the way have learned from each and every one of them. You know,
15:09 certainly my parents in different ways have been leaders. That's that's helped kind of form who I am. But as much as
15:15 anything else, I I just, you know, try to be present and pay attention. And there's almost no conversation that I'm
15:20 part of or, you know, if I'm watching somebody speak, then I'm not saying to myself, I would want to do that or I
15:26 wouldn't want to do that. Um and it's the biggest the biggest uh
15:33 I guess factor in you know my developmental leader has been failing. You know I I it's it's
15:40 really important to for any leader to fail you know learn from it um and
15:48 survive and come out the other side. You know it's and I always say this and I've said this in every leadership role I've
15:54 been in. I have three daughters. any one of them could run could do my job in any situation where things are going well.
16:01 Um, where you really find out kind of how how folks respond is when times are tough and you know and and and I have
16:08 learned I learned kind of early on and I think raising daughters is a is a great teacher to this you know to try to
16:14 maintain a certain level of um not getting too high, not getting too low because um as a leader everybody looks
16:20 at how you respond and they're going to take you know they're going to take a position based on that. So, you know, I
16:25 try to always remember that and um you know, I will never feel like I'm I'm who
16:31 I want to be. Uh but I try to, you know, take all those lessons and some of it is, you know, formal kind of coaching
16:37 and things like that, but experience has been, I think, is by far the best teacher. If the Heart and Hustle podcast has ever
16:43 sparked any idea or made you think differently, do us a favor. Make sure to guys share this, post it on LinkedIn, or
16:50 even text that nonprofit friend that you just have. Whatever works. This is what
16:56 keeps the conversation going and allows us to just grow this community together. Seriously, we appreciate you. Experience
17:02 is everything, man. I I always say experience will teach you more than school ever will. You know, and I used to get so mad at
17:09 the level of I was a general manager at 19 years old and you had someone that comes with a, you know, four-year
17:14 degree, but I'm running circles around this person. However, that piece of paper always got them the job, right? But I'm like, you can't teach what I
17:21 know. You know, this person. So, I wanted to kind of go back to something else you mentioned. I remember I was 19,
17:27 probably years old or maybe even younger. Maybe I was 18. And that director of operations comes into the
17:32 store. Mind you, I'm this 18, 19 year old boy, very young, thinking he knew it
17:37 all. Um, there was no manager. So, I'm like day in day out, like that's just my work ethic. Like, I was there. I was
17:43 knocking it out. And I remember him, I'm doing all the inventory, all the ordering, everything that you can think of, I'm doing it. And I remember him
17:49 showing up one night and there was a mess in the store, but I was there by myself. Nobody helped me all day. So, of
17:55 course, I'm livid at this point, right? And he comes in and he he's, you know, saying, "Ephra, what is wrong here? Was
18:00 this?" And I'm I'm just spazzing out on him saying, "What do you mean? Like, I've been here doing this. I've done the food truck. I've done this." He says,
18:06 "Ephra, anybody can do it, but is it done right?" I got so mad, but it was so
18:12 real. kind of to what you just said, right? Anybody can do it when it's good, Ephrain, but is it being done right at the end of
18:18 the day, you know, are are you actually leading or are you just doing it? And um I would never forget, man. So, I've had
18:24 a lot of leaders that I could remember what they said. Anybody come to mind, top of your head,
18:29 wife, old friend, old coworker, just that one thing that resonates with you that you still hold on that somebody
18:35 said to you? Uh yeah, I I mean I there's so many that
18:41 come to mind. uh one one mentor of mine, Carolyn Hines, she was we used her a few
18:46 times as a consultant and you know some one of the most kind of profound things
18:51 she ever said to me was really simple and it was it was around if you know if somebody's coming to a to you with a
18:58 problem it doesn't mean it's yours to solve right and wow
19:04 you know and and one of the the the thing that I'm probably most proud of in my career is folks that I have I've
19:10 worked with or have worked for me seeing them ascend in their career and I like to think I play you know some small part
19:16 in that but her advice and I was a young leader at the time. Um and this is you
19:21 know I I try to follow this same logic at home with my wife and family. I'm not nearly as good at it because I always
19:27 want to fix stuff but but her point was you're one you're letting them off the
19:32 hook and number two you're really not teaching them anything right what you're teaching them is to come to you when
19:38 they have a problem and you'll fix it. Um, and and that was a little bit of a hard habit for me to break. But as I've
19:44 been able to do that, I've really seen, you know, as people have come with problems, I I more respond with, okay,
19:52 and and what what's your plan? Um, or if they even worse, if they come talking
19:58 about another member of the team, well, what did they say? Right? To really try to kind of redirect that energy. And it
20:03 seems like a really simple thing, but it's also when you're used to kind of when my career was ascending, it felt
20:10 like I always needed to solve a problem and do something and demonstrate my effectiveness. Um, and what I've learned
20:16 over time is that's probably even more effective than being the the fixer or the problem solver.
20:23 That was a good one. That is true. I'm I'm that guy. Anyone comes to me to a problem trying to figure it out or find
20:28 someone that may know it. And a lot of times that's just Yeah. the wrong way to kind of go around that, man. Uh that's a really good lesson. So in the space of
20:35 you growing, we talked about just the growth and where you guys been able to do for the last couple of years. You also want to double the states. You're
20:41 in five states now. Of course 10 would be definitely where we want to be. But what is that biggest barrier and maybe
20:46 the biggest unlock to actually making that jump from five to 10? Uh well I I don't know if the the
20:54 entering this so there's there's two ways we grow basic three ways. one, you know, is based on the existing book of
21:01 business growing organically and and we are growing probably twice as fast as
21:07 the rest of the market. And that's because that's entirely little bit because of some of the support we provide from an
21:12 infrastructure standpoint, but it's really putting our frontline supervisors, branch managers in a
21:18 position to go win and recruit and and have great relationships with our referral sources. So, that's that's one
21:24 leg. The second is in markets where we're that we're in, you know, we want to have a significant amount of density
21:31 so that as we have we so that we're in a position to be able to have meaningful discussions with our state partners
21:37 around the design of the system and you know rate structure and bureaucracy that that flows around our services. And then
21:43 the third leg is identifying the right markets to enter. Um and that's a little
21:49 bit of science and a little bit of art. But if you look at the states we're in today, we're in Rhode Island, Minnesota,
21:54 Virginia, North Carolina, and Ohio. Um, and those five states,
21:59 they have nothing necessarily in common other than the fact they're states that have demonstrated over time they're very
22:06 supportive of inhome services through Medicaid, right? And that shows up in a variety of different ways. So, not that
22:13 it's a barrier to growth, but we are very deliberate about identifying state partners that um are the right fit from
22:20 that that standpoint. I mean, we want to make sure that they have a rate structure in in place that allows us to
22:26 pay our caregivers what you know, what we deem are competitive, meaningful wages. Um and and every state's a little
22:33 different related to that. So, that's one thing. Um and then I think just from a from a capacity standpoint, you know,
22:40 we've grown very quickly and we want to continue to grow very quickly and we
22:46 don't want to sacrifice the culture to do it. So it's also there's a bit of making sure you know that we are we have
22:53 the infrastructure, we have the technology um in place on more the technical side of things, but that we're
23:00 able to get out and still do that face to face touch um with our constituents. I mean I I still try to meet every
23:06 single incoming acquisition face to face in person. Um and you know some of those
23:11 things we just we I don't want us to sacrifice. Um so some of it's pace of growth, some of it's making sure we have
23:17 the infrastructure and the other is uh you know making sure that we we enter the right markets.
23:23 I mean no better leader to get this done than you. I mean you've clearly done a phenomenal job. So you'll continue to
23:30 scale whether organically strategically. I can imagine that you guys get to 10 locations. What is your When you think
23:37 10 locations, how long do you think that would take you? Year, five years. Uh, speaking to existence, Michael, I'm
23:43 a big believer in speaking to existence. I I think 10 is within three years and I
23:49 think we're probably halfway there within a year. Oh man, I love this. I love this. And to be and you know, and it's not
23:56 just to put a fl, you know, a flag on the map. It's to, you know, when we enter a market, it's it's the beginning.
24:02 So, you know, we entered Minnesota in April of 2024
24:08 with one one partner. We're now up to five there. Um, so that that's that's
24:14 really the, you know, it's enter a market and then try to build relationships to expand um within that
24:20 market and then become become meaningful. That's again, you know, as we start start to talk to some of our constituents, we're helping
24:27 professionalize that, you know, and and there's, you know, as we think about innovative ways to expand the services
24:33 that we can provide, um, you really kind of need some scale to be sitting at the table for that.
24:39 I love this, man. And what what listeners should know is whether they know it or not, everyone's going to need
24:44 this kind of care or provide it to be quite frank. What should they be thinking about right now?
24:50 Well, it's hard to think about it until you need it, unfortunately. I I mean, in in in some cases, um, and and that's
24:57 probably more the case in the our senior population. For the folks we serve who
25:02 happen to have an intellectual or developmental disability, um, it's a little different. I mean, those families, and that's about half of the
25:09 families we serve, they have been advocating for their what becomes our client for their whole life. Um, you
25:16 know, from from birth. Um, you know, so it's it kind of raises the bar for us to be able to, you know, jump in and earn
25:23 their trust. Um, but I think the thing for families to to recognize, I've
25:28 worked in pretty much every venue of healthcare from nursing homes to hospitals, we've had group homes, and I
25:36 I there's no question in my mind the safest, most convenient. Um, you know,
25:42 healthiest from a community and and social integration standpoint is at home. Um, and I think, you know, a as
25:51 folks start to contemplate, you know, the needs of their loved one, um, or personally themselves, just making sure,
25:58 you know, there's an understanding of the services, how they're available. Um, the Medicaid system, it generally is
26:04 very difficult to manage. And that's where folks like us come in to try to help um, you know, help folks navigate
26:11 that. and for families who are looking for care for like I needed care for my father. Um I didn't do anything until I
26:18 needed it. And you know it's a big uh it's a race to catch up. And and and for
26:24 a lot of our families it's it's as simple as find me the right person who's going to reliably show up that I can
26:30 trust. Um and that's those are the kind of caregivers we look for. We can train across the board on any of the technical
26:37 skills and the things the needs specific to the client. But um you know I I
26:42 couldn't be more proud of 8,000 caregivers we have out there and you know the amazing things they do that are
26:47 above and beyond every day. They you know they talk about these things as ordinary kind of events in the course of
26:54 what they do to you and I they're extraordinary. Um and these kinds of
26:59 things are happening all the time. um not just with Amabe but you know in this profession as a whole and I'd like to
27:06 think we we as a company cultivate that and bring out even more of that the best
27:11 of that in the caregivers. I'd love to hear that number man. 000, you know, caregivers cuz we also kind of
27:18 experienced for the last couple of years a decline in caregivers, right? Looks like you guys are still scaling up,
27:24 bringing um caregivers back to what they love the most and a lot of it is the technology. A lot of it is, you know,
27:29 helping them in a sense of doing more of what they love and less of the things that they don't. Um so I think that's where we're seeing a lot of increase
27:35 when we're starting to implement those right things. And kudos to you, man, for even, you know, thinking beyond that and
27:40 finding those people that have a passion, right? That purpose and not just so much chasing that paycheck cuz this this line of work is not all about
27:47 paychecks. It's about doing the things that you love, about helping others. Um, and you guys are doing it quite well,
27:52 man. If someone wants to support this model in the community, where do they start?
27:58 Well, if they um want to join this model with Amie, they can go certainly go to
28:03 amov.com. Um, you know, we are always looking for not only caregivers but prof for
28:09 professionals as the organization grows and I think, you know, generally
28:14 throughout the community there's a lot of similar um, you know, providers. Caregiving is it's a calling. It's
28:22 there's, you know, there Target's always hiring, Walmart's always hiring. That's not who we that's not who we employ. The
28:28 folks that that we hire, um, they want to care for folks. And um you know and I
28:34 certainly think there's a fair amount of them out there and and I think you know there's a there's you know given kind of
28:39 my experience um I've seen a lot of cases where you know I've I've seen
28:45 caregivers nurses whoever transition from more of a facility you know hospital setting into the home not
28:52 knowing what it's going to be and it doesn't always work out but many times there there it's just such a fulfilling
28:58 experience because they're able to build what really is a long-term relationship with their client. Um, and and that
29:05 opportunity doesn't exist in more of an episodic kind of acute or even home health setting. Um, so that's one of the
29:12 things that just makes it different. And it's not for everybody, but you know, it's the thing for 8,000 folks at Envy.
29:20 As we start to wrap this up, man, what's your biggest hope for how homebased care will look like in the next 10 years?
29:27 My biggest hope is that um
29:32 it's recognized for more than just uh companionship, right? Because I think in
29:38 some um you know some folks view it as we we are inherently a nonclinical service. Um
29:46 but we are also the first eyes and ears. We are the our team is signaling when
29:53 there's there's potential um you know hazards in the home potential you know
30:00 medications not working together well we're the you know there's a lot of talk about tele medicine we are the manual
30:07 tele medicine in the home um and our folks are able to pick up on things that
30:12 ultimately prevent hospitalizations now we haven't and that's just as an example we haven't gotten to the point where we
30:18 can fully demonstrate that with data. But my hope for the industry is that it's recognized as a key part of the
30:24 clinical continuum even though inherently the work that our team does is not um inherently clinical. Um but we
30:32 are the eyes and ears. We you know we're the first person family members call and um and I know that you know I know how
30:38 important it is to the families because you know they care they advocate so much
30:43 for their caregivers to stay with their loved one. um you know and and and we've
30:49 been fortunate that we've been able to continually kind of increase wages over time largely with support from our
30:55 states. Um but to make it more of a career for a lot of our caregivers as opposed to, you know, a job. But I think
31:02 recognition along that continuum would be what I would hope for. I just love that you're talking about
31:07 growth and expansion and paying more because I've spoken to a lot of leaders and it's kind of quite the opposite,
31:13 Michael. So clearly you are doing something amazing. Um, and I just wish
31:19 you nothing but success, right? That that those locations, um, more states come even sooner than what you think.
31:25 But I leave you with this blind question here, man. You spent your whole career trying to serve the underserved. What's
31:30 one moment that made you question whether it was working and what kept you walking from walking away?
31:39 To be perfectly honest, I've never considered walking away. Um, never never
31:44 have met. Um, that's one thing I I I don't I don't know that I've ever done. Um, that being said, there's it's
31:54 when the pressures mount in in things that truly cannot be controlled. Those are the most frustrating moments because
32:01 I I you know I and and our team has a very high bar around we control 90% of
32:07 the things that happens in this company even if it's you know based on external influence. That being said, from time to
32:13 time, um, you know, we're dealing with a a particular state's budget challenge now. Um, and it's just creating turmoil
32:21 that we have no control over, right? So, what we try to do is boil that down into what we can control. But, but I think,
32:28 you know, it's not getting me considering walk away. But those are the most frustrating moments that everybody
32:34 knows we're all trying to do the right thing. And you know when political forces kind of get in the way and things
32:40 like that that's that becomes frustrating. Yeah. A little challenging. Nah, you're right. You're right. I think that's
32:45 where we all are, right? That challenge of how do we continue to move forward? No, I appreciate you, Michael. I really appreciate the conversation just being
32:51 so open and authentic. And um guys, if you guys are asking yourselves, how do you get involved? What was the website
32:57 did you mention, Michael, that they can go and figure out more information about this? It's am.com.
33:03 And are you guys on social media, Instagram, Facebook? All the socials are linked there. So we're on social media.
33:08 Um Facebook, LinkedIn, Instagram, uh text. So you can find us anywhere.
33:14 Everything. Anything that is social you guys are on. I I appreciate you guys are with the times. Well guys, if you guys are still listening, make sure that you
33:20 guys do subscribe, like, and comment and check out some of the work that is being done in a space that sometimes people don't even like to talk about until it
33:25 happens. Guys, my name is Era. This is Michael. We'll catch you guys in the next one. Lers. Thanks.

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