Techquity Series: Tackling Breast Cancer Disparities with Digital Health

[00:00:00] Joy Rios: Hello, and welcome to the HIT Like a Girl podcast. My name is Joy Rios, the show's host, and today we are embarking on an exciting journey through our new five part series focused on Techquity, which is the intersection of technology and health equity. In this inaugural episode, I am thrilled to welcome Janna Guinen from the Health Foundation.

Janna is at the forefront of this initiative advocating for equitable digital health solutions that cater to the needs of underserved populations. Janna, thank you for joining us today and help us unpack what Techquity actually is, why it matters, and what we can look forward to in this series.

[00:00:45] Janna Guinen: Thanks, Joy.

I'm really happy to be here to kick off this series of five guest episodes focused on Techquity and healthcare, each of which will feature one of our feature five winners of a Techquity for Health case study competition. And just to set the stage, so Health Foundation is a non profit organization and we're focused on five imperatives for sustainable and ethical health care, which are access, affordability, equity, inclusion and innovation and technology.

When you think about it complicates all of these variables in healthcare. So about a year ago, the Health Foundation started the Tech Equity for Health Coalition. And as a coalition, what we're really trying to do is help the industry understand and manage these factors so that we can have greater success and consistency in addressing health disparities through digital health.

Technology can be the hero or the villain, and it needs to be at least a good like supporting actor in the story of health equity. And that's why we started the coalition. And then very specifically, the coalition is working on defining best practices and recommendations and also looking at metrics that we can use for digital health equity again, or tech equity.

Before I go on, I just want to take a second and give credit. And say thank you to the organizations that stepped up and supported the coalition from the very beginning before it was really anything but an idea. So big thanks to the American Medical Association, Amazon Web Services, Epistemics, Outcomes for Me, UST, also the National Association of Community Health Centers, ResMed, Empirics, VSP, Global Innovation.

We've had some fantastic support to get off the ground. And also I have to just give some credit to our dedicated and really experienced group of advisors that are helping to drive this initiative who have just been an incredible and valuable resource. And we have a lot of fun as a group too. So thank you to the advisory committee of the coalition.

And then this, that brings us to where we are right now. The Techquity Coalition just completed its first case study competition where last fall we put out a call for cases and we're completely thrilled to get about 200 submissions from across the industry. It was one of the exciting things about this is not just the number but the huge variety in these case studies.

Across sectors, settings, technologies, just a great process for us to learn and to understand the landscape of techquity right now. And in the end, we awarded 11 projects. This was at the end of February, at the VIVE event, we held an award ceremony. It was really fun. And then just to explain why did we do this?

The whole purpose for this competition was to bring visibility to the best practices as they stand today, to confirm our understanding of techquity how health equity can really show up when we're implementing or innovating in digital health, and then to look at novel approaches to techquity and healthcare.

And it, it really did give us some very interesting visibility into the landscape. In each of the five episodes in this series, as I mentioned, we will feature one of the winners of the case study awards. They'll talk about their projects, the insights what they've learned, and we'll have a guest host, a different guest host for each of the interviews, which are one of the coalition advisors.

This has been great because we are, our winners actually, there's a sort of a relationship. We were able to find an advisor to conduct each one of these interviews who is in one way or another kind of connected to or doing work in a related area. So great conversations.

So here's the final thing. In just a moment, you'll hear from our first guest, Anna Kravitz. Anna is the president and the Co-Founder of AdirA, which is a digital strategy consultancy. So she recently sat down with Andrea Werner, who is the Chief Population Health Officer at Emplify Health by Bellin and Gundersen Health Systems and an advisor to the coalition. So I'll give you a little bit of background on what they're talking about here.

So Anna and her team at AdirA were challenged by Merck to confront the issue of high mortality rates from breast cancer among black women. And just I want to share one statistic. Black women have among the highest incidence of breast cancer among women in the U. S. And women younger than age 50 are twice as likely to die from breast cancer as white women.

So black women younger than age 50 and also black women have just a higher overall mortality rate just at any age from breast cancer. So it's a big problem. So Merck sought to enhance awareness and encourage earlier and proactive health screenings among younger black women. Going after consumer behavior is one way but patient behavior just make sure they understand the need and that they're able and know the resources to follow up and how it pertains to them. So what AdirA did and their response was to develop Nia?

And Nia is a digital guide was created to educate and also to really provide like genuine support to black women and It really resonates with them. It's, you'll hear Anna talk about their success rates, how long people stay and really do the consultations with Nia and different measures of success that they use.

But in any case, this is an initiative that's really a standout example of how very thoughtful, targeted, and culturally relevant interventions can make a significant impact. So I'm excited for you all to hear it.

[00:06:25] Joy Rios: Wonderful. Thank you so much for all of that setup. And I can't wait for our audience to listen in to this conversation.

So without further ado, let's dive in.

[00:06:34] Andrea Werner: Hi, my name is Andrea Werner, and I'm the Chief Population Health Officer for Emplify Health by Bellin and Gundersen Health System, and I've also had the privilege of sitting on the Techquity for Health Coalition for the last couple years. It is a privilege for me to interview today Anna from AdirA Health to learn about wonderful work that she and her team are doing with a solution that is called NIA.

For me, leading population health, it has become crystal clear for the last couple years that the intersection and interdependency between technology and improving the health of our communities is so important. And a lot of the health tech companies that we are learning about these days are really solve one problem or another as it relates to delivering triple aim or quadruple aim or quintuple aim.

So when we think about equity results to the communities that we serve. So Anna, maybe you can introduce yourself, tell us a little bit about your story and how you got started with AdirA and then bring us into learning a little bit about Nia.

[00:07:37] Anna Kravets: So my name is Anna Kravets and I'm a co founder of a company called AdirA.

AdirA is really was born out of the need to help people navigate the complexity of our health care. There is a lot of information, a lot of education, but what we decided to focus on is help people to take health action because there's so much information people can drown in. So we are a consumer health action company.

My co founder and I started this company to really focus on helping people navigate the complexity of health care, but specifically help people deal with the mountains of information and come to what is absolutely relevant for them and can help them lead to the proper health action for themselves.

So we started at about a little over five years ago, we build a number of solutions, both for private sector and public sector, we build some of the platforms that we own that have not been sponsored by anyone and always had health equity in mind because we felt that health action has to be achievable for everyone in the country. So we're not just health equity company, but our health action is focused on delivering it for everyone.

[00:09:07] Andrea Werner: So double click, if you will, on NIA and the solution NIA. What problem were you trying to solve with NIA?

[00:09:14] Anna Kravets: So when we looked at the issues that exist in breast cancer. It's a complex topic for a lot of people to navigate, but specifically there was a much higher kind of barrier to overcome for younger black women. I don't know if everybody knows, but for younger black women ages 25 to 45, so it's in this pre guideline phase for a regular screening, such as mammogram.

That population tends to have very poor outcomes. They're more likely to get aggressive forms of breast cancer, called TNBC. They're more almost three times more likely to get that aggressive form of breast cancer. In addition to that, because they get it at the younger age, oftentimes when they turn to the doctor, what they hear is, you're too young to have breast cancer.

The normal screening, it doesn't work very well, because they have denser breast tissue, so because they are not being heard and for their issues, the outcome is they tend to be screened later, diagnosed later, and the ultimately younger black women in that age group end up with a 41 percent higher mortality rate from breast cancer than white women of the same age group.

So what we wanted to focus on is to help younger black women to understand signs, symptoms, and the risks of breast cancer for that, their population, and be able to advocate for themselves. It started taking a more active role in their breast health, things like self exams, regular clinical checkups with their doctor.

So when something starts changing, they can catch it earlier.

[00:11:23] Andrea Werner: So the Techquity for Health Coalition has really been focused on thinking about technology that can equally distribute access to services, provide tools that are engaging and empowering to all populations. And one of the things that I loved about Nia and one of the reasons why I scored Nia high in the radiance as a reviewer of these cases is the fact that you co designed the solution with people who have lived experience experts who came from the community.

Can you tell us a little bit more about that Anna? Who did you partner with?

[00:12:03] Anna Kravets: Absolutely. It takes a village to tackle difficult problems. First of all, I wanted to mention and acknowledge that the sponsor for project Nia is Merck pharmaceutical company. So they provided sponsorship and thought leadership around the subject matter.

Our expertise is health action. Our expertise is not breast health necessarily this clinical domain, but to make sure it's clinically relevant what we have done is brought in. black women's health imperative to really bring that voice of the community. So we worked with them to really zero in on that population.

They helped us organize several focus groups and moderate those focus groups. Actually the moderator herself is a black woman who is breast cancer survivor. So it really helped to bring that relationship and with the women that were part of the focus group and make sure that they felt comfortable to speak up about their experience.

We also worked with Black Women's Health Imperative to really, so the direction for the visual design, both for the look and feel the palette, the tone of the conversation design of the avatar for the experience was very important for us, making sure it's someone people will find relatable, but at the same time, they can connect with that avatar that they're having conversation with, and Nia is the name of the avatar and hence the name for the project Nia.

And we knew that we got the design, right? One of the reviewers from the community saw it and said, Oh, Nia looks like a cousin who made it, right? So it's like a cousin. Someone is from my community I can relate to, but at the same time they, I can look up to them so I can take their advice.

In addition to bringing the cultural expertise, sourcing it from the community, we engaged with the clinical expert from the community as well. So the clinician with whom we developed the algorithm for the digital conversation, Dr. Christy Johnson is herself a black female clinician who practices in Philadelphia and sees the population.

So we bring in both from the clinical and then the cultural and we try to immerse herself as much as possible with the representatives of the community we're trying to reach.

[00:14:45] Andrea Werner: I have to tell you that I experienced Nia and it was a really interesting experience. So I went out there and I found her in the Bellin region within our enterprise.

We have a promise that we talk about and it's I will know you. I will show you respect. I will go with you on your journey and I'm here to help you. That's what Nia was doing with me all the way along. And what was so interesting is that she would ask me questions and I had to be honest with her about an opportunity I have to improve with self breast exams.

And it was so awesome because she did not feel bad about it. She framed it in a way where great, like you, you could, but you could do better if you did this. She was instructional. I felt like she displayed empathy and it was so fascinating. And she kept telling me that at the end of the experience, I would walk away with a personalized report that I could take with me on my own health journey.

And I thought that was so fascinating. And all along, I could tell that she was designed in a way to meet people where they're at, not only culturally, but as unique individuals as we engage with her. And one of the outcomes that I'm really fascinated with the Nia solution is the amount of time that people are willing to engage with her.

So Anna, my understanding, a really impressive outcome measure for Nia is that 66 percent of women who engage with her longer than four minutes, and 25 percent of people who engage with Nia engage with her longer than eight minutes. For me, I found myself spending a lot of time with her, partly because I was a curious healthcare professional, but also because Nia was challenging me to be a better steward of my own health, and it was fascinating.

But I think that's an outcome measure that is truly impressive. What other outcome measures or measures of success would you highlight for us that you're proud of with Nia?

[00:16:47] Anna Kravets: There are actually a few things. One, I would say is just targeting, making sure that we get to the right people because how many young women that are otherwise healthy, may not realize that they have this higher risk factor for breast cancer, would want to click on and add and talk about breast health.

So making sure we're able to reach and engage young black women was something that we were not sure initially we'll be able to achieve, but because we have this kind of continuous loop between our outreach campaign and data coming from that and the data coming from the experience, we were able to get very tight targeting and about 60%.

Of women that we, that come through the experience are black women, actually young women who ages 25 to 44, basically sub 45. And we have another pretty good number of women in that 18 to 24 age group. We, our experience is not under 18. So we're politely people that come that are under 18, but that think about that number of women in that younger age that are curious about that topic and starting to think about it early.

So we definitely got our age targeting down and then race also were close to 80 percent with getting right race targeted. And one of the things is we definitely are not excluding anyone else, but young black women first type of solution. It's mainly for them, but we have somewhere between 16 to 17 percent of combined white and Hispanic coming to the solution, and they still get the meaningful experience, but they're not the primary audience.

So definitely getting the targeting right, something that was pins and needles for us in the beginning, making sure that if we're trying to help this population. We're able to reach them. The second thing is the completion rate. We talked about how long women engage, but we also have this benchmark for us, how many women who start the experience actually complete that? And there we are at somewhere for the life of the program. We launched late last summer, we somewhere around 16, 17%, but we are continuing improving. So we're higher, but the blended completion rate, which is three times industry average. And again, going back to the example I mentioned from the New York state WIC program, and that program is called Project Wanda is sister of Nia.

There was a concern. If we're able to meet the industry standard of about five to seven percent, but we were able there to beat it and be somewhere around 15, 16%. So here we're doing as much, if not better.

[00:20:16] Andrea Werner: It's so fascinating to me in population health, we think a lot about really solving those last mile problems.

What do we really need to do to reach everybody to drive outcomes and impact? And what just struck me is that you're leveraging technology in the spirit of equity, and you're doing it by myth busting. You're creating a credible avatar, a credible experience. And you're busting the myth for these young black women and you're giving them the facts and you're equipping them with tools and information, a report, a guide to do the right thing.

And normally these women may not have access to these types of resources and information and you're creating a new narrative for the right thing to do with for breast cancer in young black women. It's really awesome.  It’s really awesome.

[00:21:09] Anna Kravets: Thank you. We definitely, we want to give them agency. We want them to be able to come first of all understand and take in that this problem exists, give them knowledge, give them tools and give them resources to have that better conversation with the doctor.

We're not there, of course, to replace the doctor, but we want to make sure when they go for those checkups, they come informed and being able to advocate for themselves. Because as I said, we heard the stories of women getting a long, windy road towards diagnosis, feeling something is off with them and not being heard the first few times when they voice their complaints, or sometimes even themselves not realizing that if I'm feeling something is off, it's important to go and get checked, but you would know that something is off if you know what the signs and symptoms are and what are you’re risk factors? 

[00:22:17] Andrea Werner: I love the thought of giving agency and that's exactly what you're doing.

Knowledge is power. Having someone support you, giving you information so that you can take charge of your health. I absolutely love that. I'm curious, what was your biggest surprise in all of this? Good, bad, what was the biggest surprise or biggest learning that maybe you didn't expect?

[00:22:39] Anna Kravets: That's a good question.

The biggest surprise, we were a little bit, again, speaking of myth busting, there is this notion that there is a complete mistrust of pharma industry among patients, among the population. So we were not sure. If our statistics off engagement and completion would be on par with our other solutions, we've built solutions for travel health for contraception for, as I said, this women, infant, children program, and we had very good engagement. 

But this time it was very clearly stated that it's sponsored by a pharmaceutical company and guess what? We meet the same levels of engagement and in some cases even had better performance. And that speaks to it doesn't matter who sponsor it. If you do it right, if you show through your solution that you're speaking authentically, you truly care about them.

You treat their time with respect. And you treat them with respect and you don't talk down to people. You don't judge them and you give them something useful and relevant at the end, people will listen. People will work with you. People will take your advice and the information. So I think one example again, going back to the solution that we have done for New York state for one, when we were testing and that one was the person participating in the research or giving feedback on the solution was a man taking care of the nephew and needed some support with nutrition. So went through our experience called Wanda, came to the end of it and said, “Oh, that was simple. I got everything”. It was quick. And you know what? It didn't make me think less of myself, right?

Because a lot of time, even in the sense of efficiency or getting to the point of things people feel like they're being talked down or it's some sort of going through the process type of experience, and it's hard for people to talk to another human at the time when they are vulnerable. They're not sure of themselves. That meant the world to us, right?

It's those little comments, little remarks. And we spend a lot of time making sure we get the voice right, the tone right of that conversation, because each of our solutions has its own, a little bit of the personality, a little bit of fun, making a joke. We hear there and depending on the topic, obviously we keep it within of what it is, but things don't need to be boring, right? Even when you talk about serious topics.

[00:25:58] Andrea Werner: Absolutely. The Techquity for Health Coalition, we talk a lot about technology and the role in preventing further advancement of health disparities and closing the gap on disparities and solutions like the ones that you're describing, where you do the research and you do the hard work and you get to know through voice and through data each unique population that you're serving just is so powerful.

I think it's just incredibly powerful and you're working with communities and populations who have had to struggle in the past and giving support right from the very beginning with the solution based on research, and again, through collective voice and experience, I think is just one of the most powerful things in the space of techquity.

That's one of the reasons why you won the award that you did. Congratulations again on that one. What do you look forward to next? What is your next horizon with AdirA and with this great work that you're doing?

[00:27:04] Anna Kravets: There are a few things. We're currently working on a few other solutions, some of them are in oncology space as well.

I cannot talk about the specifics yet, but once they launch, I'm sure we'll want the world to know we're also looking to build solutions that are more open for broader collaboration and participation from the ecosystem. Because I think it's really important to, especially for those complex problems for various organizations, whether it's public sector, private sector, academia, to be able to come together and leverage what was done by others and add on to their solutions.

So think about having, we now have this great tool that provides that education and then personalized curated summary of resources for women. Wouldn't it be wonderful to have other organizations that want to close the last mile of actually finding the doctor, setting up an appointment if someone doesn't have a doctor or really…

So one of the things we also always include in our solutions is social determinants of health assessment of what gets in the way of you getting care that you want, that you need. Everything from transportation, child care, work, and so on. There's so many organizations that provide those services. So being able to at the end of it to connect into all of that.

So we don't just give like a summary guide with the resources at the end. But we provide integration and we've done that for our health and travel platform. At the end, if a person is interested in, after we help them understand food and water safety, vaccines they need for the travel destination they're going to, they want to we help them schedule an appointment for pre travel health consultation.

But that's the platform that we own ourselves and there is no constraints of what can be sponsored by different sponsor. So we really would like to do more of those solutions that multiple parties can participate in. So we're thinking of applying for some grants so we can build those more solutions that are open for collaboration and participation for everyone who is interested.

[00:29:51] Andrea Werner: So partnerships I think are one of the most powerful things in those of us and who are part of organizations and individuals who care about advancing health equity. How do you approach. partnerships or what are your thoughts on partnerships?

[00:30:08] Anna Kravets: We partner as much as possible. One thing or one guiding principles for us in AdirA is not to build anything that already exists in the market.

And also, strong recognition that we're not experts in everything. So we are self funded bootstrapped company. And from the beginning, we decided that technology wise, there's so many technical platforms. In the market, we'll find the right ones. We'll partner with them. We'll leverage it. And what we will focus on is a what I have seen as a tremendous gap in the innovation of health.I.T. Innovation across the board is coming up with really good use cases. For various technology, defining your problem. Bringing the data that has the evidence that it's a problem and having those statistics, because that helps you define a good solution that you can also measure. Are you making a dent?

By your solution in solving that problem. Number two, executing it with as much care, creativity, fidelity, cultural intentionality, focus on excellent user experience, beautiful design good content, that's another. piece is a great execution of the solution to a problem to the use case that is well defined.

And then last but not least is operating it well, because oftentimes wonderful things are built and then they put out there. And if they don't get continuous care and feeding and looking at the data and feeding what you learn from the data back into improving your solution or maybe modifying it to, to be a better solution and using this data to identify opportunities for other unmet needs and maybe create either expanding your solution or build a new solution.

It's no good for anyone, right? Everything needs care and feeding. You plant a beautiful garden, if you don't weed it, it's gonna go bad on you quickly. And because of that philosophy, we wherever possible, we bring the right expertise. We're experts in defining the problems well. Building great consumer health action solutions we're not clinical experts in any particular clinical space, as I said, we've done solutions, everything from nutrition to cancer, to contraception, to travel, health, you name it for those.

We bring the right clinical expertise and we typically work with people who are not just KOLs and focused on just high level thought leadership. We want people that actually work closely with the patients because our solution is patient facing and we see our solutions as almost like an extension of that clinical capacity into the form of that digital conversation.

So we can take 80 percent of the common topics or ways that is framed and existing people and digitize that. So we bring in clinical partners, we bring cultural partners depending on what it is, we work with outreach partners that have maybe footprint in the community, or oftentimes when we do it for sponsors, they often have agency already doing digital outreach. 

But we engage with them in a completely different way that they've ever worked with anyone else, any other digital solution. We have weekly meetings with them. We compare notes. Of what we're seeing in terms of the traffic that comes from that outreach how they're behaving We're in a modern like giving them that feedback.

They refine their campaigns their messaging their targeting we were able to make tremendous improvement from the initial start of those campaigns to how well they're performing. Ultimately, when we get into a steady state, so we partner a lot. 

[00:34:50] Andrea Werner: And I love that you mentioned humility as a key to could be a good partner.

And I love that you gave a strong nod to quality improvement. I always say life and work is one big PDSA, one big quality improvement project. So when you think of the solutions that you have at AdirA, do you have a standard scorecard for all your solutions that you use and metrics that you look at across the different solutions?

And do you have a common way of reporting those out to stakeholders and then improvement methodology that you use? Or how do you go about formally integrating that into your work?

[00:35:27] Anna Kravets: Yeah, because we're very clear about what we do. We know what the problem we're solving and it's data back and we know what help action we're looking to affect.

Basically between that, that sets the framework. So people, we know who we're targeting. So the first thing we always focused on, are we getting the right people who this solution is for? Cause if we're not, we are spraying and praying. We are very specific about who are we after. And because we know what we're trying.

Basically for them to complete that experience, we’re driving that to the, that point that we consider like a completer, there are certain milestones on the way to that. So every solution we have, we built has what we call funnel, right? People that come and then what happens with them? Where are we losing them?

And we monitor that. And we adjust our solution both from starting from getting quality input in people who are actually this is for and then delivering the right experience to them. So this is why we always very clear what we report on is our targeting on point is our completion on point are people engaging long enough to comprehend the information.

And of course, with every solution we ask for rating. So going back to project near, I would say, as last time I looked about 84 percent gave a five star rating and Five star and four star combined was ninety three percent.

Imagine talking about not the most exciting topic of breast health for four plus minutes and then after that giving five star rating. It was, it is extremely humbling for us. And we're grateful.  

[00:37:29] Andrea Werner: Oh, congratulations on that. What are you curious about in terms of the next evolution of Nia? Do you see Nia evolving into doing even more in this space or do you see Nia serving her purpose?

[00:37:43] Anna Kravets: So one thing. I would imagine Nia staying there for as long as she's useful because there is always that next young generation coming in that need to be informed, educated, and activated to be serious about managing their breast health, but In general, what we try to do is what kind of why do we create experiences that we create?

Those are digital conversational experiences that somewhere three to five minutes. We call those experiences micro moments. So that's what we try to create for people because we realize everyone has their busy life. They have million things that they're responsible for oftentimes. Health is not a priority for people until it's, there's something acute.

So somewhere along the journey from being healthy to having been diagnosed and dealing with the diagnosis and so on, there are always those moments. We call them sliding doors where you can fall off the wagon and don't give yourself the right attention, the right care. It could be by just not knowing and doing nothing or knowing and thinking that it's the problem is insurmountable or you have other rhings or whatever gets in the way of you either doing the wrong thing or doing nothing.

And what we want to do is create the right experience that build those micro moments for people to do the reality check, do the education, give them tools to that health action so they stay on the right course so they can have the best health trajectory for themselves.

So what we want to do is with Nia or her sisters is to make sure that we cover all continuum. So if you think about Nia, she's in this population screening phase, but there are also people who are in this symptomatic, pre diagnosis, going through diagnosis. There's so many people that get stuck and they get something abnormal and don't necessarily take it all the way through or take too long to get fully diagnosed so they can get on treatment and so on.

So definitely, we want to build more along that continuum of disease progression and but also think about all the other things that branch out.  

[00:40:29] Andrea Werner: So I love micro moments. And techquity has such a huge opportunity because we know 80 percent of our health and being has nothing to do with clinical care.

20 percent has to do with being inside walls of a defined healthcare situation or experience. Micro moments empower a unique kind of access. Leveraging technology that's available to everyone. And so I just love that concept of micro moments because people have the ability to access information that can empower them on their terms when they want it, where they feel safe, when they have time.

And when they can act and then they can revisit it. So techquity and access walk hand in hand together and your solutions that you're describing, Nia, Wanda, are just great examples of that. Such great examples of that. You're giving access an agency. It's just brilliant.

[00:41:27] Anna Kravets: Thank you. That's access and agency with respect, without judgment. That's what we're shooting for.

[00:41:36] Andrea Werner: Anna, is Nia available in other languages?

[00:41:36] Anna Kravets: Funny that you asked that. So it's currently available in English, but the Spanish version is in the works and will be coming soon. And we realized how important. To have it in different languages when we recently launched Wand in Spanish.

So Wanda has been around in the market for about three years. And in January, we launched the Spanish version of Wanda. And what we have discovered was that overall our engagement and completion rates jumped for that solution. And within just one month, 30 percent of people going through Wanda were selecting Spanish and 70 percent English.

So there were 30 percent of people that would have rather engaged or we were losing before because they were not as comfortable in English. And interestingly, even our English completion rates improved for those 70 percent that chose that option and the 30 percent that chose Spanish option performed even better than English.

So cumulatively it was better. It's a learning that we are bringing into all of the solutions going forward. And we really advising our sponsors and partners of launching the Spanish version, if not right away, shortly, quickly after the English version.  

[00:43:15] Andrea Werner: Awesome. Anna, I would just like to express my gratitude to you, to the Black Women's Health Imperative, to Merck, to AdirA, for giving the communities that we serve collectively the opportunity to engage.

The fact that vulnerable young Black women have a resource to go to invite and engage and empower them in leading their healthiest lives is spectacular. So on behalf of Emplify Health by Bellin and Gunnarsson Health System, whom I am employed by and loyal to and proud of, and on behalf of the Techquity for Health Coalition, and HIT Like a Girl, I just want to say thank you and keep going, and I look forward to hearing in a few months and years what AdirA is up to next.

So take care and thank you so much.

[00:44:02] Anna Kravets: Thank you, Andrea, and thank you Techquity Coalition.