Marla Dubinsky, MD, and Laurie Keefer, PhD, of the Susan and Leonard Feinstein Inflammatory Bowel Disease (IBD) Clinical Center at Mount Sinai discuss Trellus Health, which provides IBD patients, caregivers, and providers digital resiliency tools, care coordination, and a network of support. Dr. Dubinsky and Dr. Keefer are co-founders of Trellus Health, a for-profit company whose aim is to develop digital health solutions to manage chronic conditions such as IBD. Dr. Dubinsky also serves on the Board of Directors of the company. In addition to Dr. Dubinsky and Keefer’s involvement in the company, the Icahn School of Medicine at Mount Sinai has equity ownership in Trellus Health. Hi, everyone. And welcome to the Innovation Cafe. Thank you for joining us this afternoon. My name is Tracy Diamond. I am the senior marketing manager with Mount Sinai Innovation Partners on. I'm very glad that today we are joined by Marla Dubinsky on Lori Kiefer of the Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. Doctors Dubinsky and Kiefer are the co founders of Trellis Health, which is a resilience driven, connected health solution for patients, caregivers and providers of IBD and complex chronic conditions. Doctors Dubinsky and Kiefer have been working together at Mount Sinai for five years, utilizing an integrated, clinical and multi disciplinary approach to better the outcomes for IBD patients. And they're here with us today to discuss digital health innovation and the technology that makes up trellis health. So please enjoy the interview tune in Onda. Feel free to leave a comment. If you have a question or anything you'd like to share right here on this post, or you can feel free toe, send a direct message to the M s I p LinkedIn page and we can keep the conversation going following the interview. So welcome Marla and Laurie. Thank you. again for joining us. We're so happy to have you here. Uh, before we dive into trellis, can you explain what resilience is and what resilience driven care means? Sure, Yeah. And so I mean, we're in. We're situated in the in the perfect place at Mount Sinai here to be talking about resilience. Um, you know, when we talk about it, at least in the context, a trellis, we're really talking about that bouncing back thriving despite the adversity of having a chronic condition in this case, inflammatory bowel disease. So, um, you know, in my 20 years as a health psychologist, working with IBD patients, e kind of got tired, actually, of asking the question usually too late about why so many patients with inflammatory bowel disease developed depression or anxiety. And, you know, one of the great opportunities of coming to Sinai to work with Marlow is that we were able to sort of flip things on their head. Ask a different question, right? Who are the warriors? Who are the patients that do well, despite having inflammatory bowel disease? And what do they have that we can give bottle up and give to others? How can we promote their well being and not just look at our outcomes as a za matter of presence or absence of disability or emotional distress. So that's sort of what led us. Thio and Marla. We'll talk a swell, but that that's sort of the goal here with Trellis. If you think of what a trellis is, right, it's a platform. It's a connected structure that really kind of elevates people and helps them thrive, supports plants to grow and thrive. And that's basically what we're doing. We're building a platform that helps people grow income their best sells. Um, despite having a chronic condition, we sort of flip the spelling of trellis a little bit to include the US the US part because we really believe in this sort of model of connecting all partners in care patients, their caregivers, their doctors, um, you know, the people who support them. And so that has really been, um, are That's what we mean by resilience driven. Excellent. Thank you for explaining that to us. So let's dive into trellis. What is trellis health Exactly. And what what's a connected health solution? Is that like a nap? Yeah. So if we take a step back and say, Where are we in the health care delivery space? And we all know that when everyone is talking about on the same page, talking about patient management and creating this sort of community of care, meaning, coordinating care. But all through a common platform, we know that patients feel more connected to their health care team but also feel more connected as it relates to their family, their caregivers, their loved ones, their partners and care. We realize that right now there's so many silos of care there is your primary care. Then maybe your specialty care, then maybe your mental health care than maybe other other areas of care. And what was happening is that everyone was talking at a different pace. Different language. And no one was looking at the patient in the center and connecting all these partners and care. So connected care really leads to improve quality of care delivery. Essentially, it's not just connected care, as it's just a I'm going to connect you with people who can provide care. It's connected health, which looks to integrate all elements of health, big physical and emotional well being right, the point was, is that we all need to be integrated and by creating a platform or a connective ity network al a trellis. We felt that that's at the foundation. We know that patients there's a appetite by consumers right to engage and connect and empower themselves to be in charge of their health. It is possible they may not have all the tools, which is where really trellis comes into play, where we want to give them the tools to feel their tool kit so that they're able to actually build something again. The concept of trellis right building something to blossom and flourish. There is also an appetite for physicians out there to be up to date with the latest and greatest gold standard approaches to these complex chronic diseases. There's so many new therapies. There's so many different care paradigms that are changing. I feel like reading daily. It's that quick moving pace that if you weren't connected to what is going on in the research or in these care paradigms, how would you know how to bring them to the patient? You know, right away so we know that about providers and patients. But there's also a customer, and anyone who is paying for health care is looking for solutions that could help identify which patients are going to need more help, which patients are going to be more high costs and be able to deploy tools or care coordination plans or play books that are personalized and help reduce the cost of care, right? So it's, you know, there's it's really all seek deliver and pay for care connecting meaning all stakeholders that to me is really connected health. And then you build sort of a solution, which is where you actually integrate all these aspects. Take away the silos, break down those silos also break down any geographic barriers because that's the beauty of being able to be connected through any form of digital solution, right, so that you don't doesn't matter where you live. You'll have access to gold standard care. That's sort of the vision or the dream of both Lori and I and the vision and mission of Trellis. I think being able to partner with the provider who already has a relationship with their patients, a trusted relationship. They made the diagnosis. They supported the patient and being able to sort of work together with the provider and be able to holistically manage illness right more at a global health view, sort of looking at it patient centered whole person and really be ableto create the village partner with the patient and the provider where they are using these, you know, tools. That and these methodologies that air grounded in research and science and actually making that available to everybody sort of creates the president's, in my opinion, as to how care needs to be delivered and how health needs to be delivered. Great. You spoke about empowering patients, giving them the tools they need for their toolkit. Thio overcome or, you know, better manage these chronic conditions and connect connectivity, which is a huge part of Charles. Can you talk a little bit more about the unmet need in the market that led Thio a specifically resilient, resilience focused, connected health solution. So I'll first talk about the disease and the chronic condition and what are sort of where the gap is, and then Laurie could speak to why laboring over resilience into that really creates the perfect relationship or partnership. So if I take IBD, for example, which just a reminder. Inflammatory bowel disease is a term that encompasses both Crohn's disease and all sort of colitis. Approximately three million individuals have been diagnosed with this disease, um, per the C. D. C. And one thing that we know is, if if about the majority don't know if it's 80. 90% of IBD patients are diagnosed and managed initially by their gastroenterologist who may not be working in an IBD center, for example, or may not have a multi disciplinary team such as nutrition, dietitians, social work, psychology, pharmacy All the things that me and my colleagues here at Sinai have been have been so blessed with these. All these resource is that Sinai itself believes in and allowed us to really grow and build a program that we deliver pen to paper analog every day in the IBD center. We wanted to be able to say that maybe for those patients who can't make it to New York or can't make it thio an IBD center in their area geographically limiting far distance, limiting insurance, limiting, you know there's many reasons why people can't access necessarily gold standard care or may not know that there are centers of of MAWR expertise where clinical trials are being done. Surgical expertise, radiology expertise. You know there's training, the more patients you see. It's a volume business, right. The more you see, the more information you have and the more you could teach and learn and educate and almost use more your own sort of predictive analytics as to what you know is gonna happen next. Based on you've seen this before. So this is really an exposure issues. So imagine if we could provide this level of care to my colleagues in the community who don't have access to these multi disciplinary teams. That would be, you know, a wonderful thing to say. All right, I know that you didn't maybe do three years of fellowship specifically focused on IBD, or you don't have an IBD program per se, and you don't have access to re sources that are often not paid for. We're going to come in and we're going to teleport into you, and we're going to help you manage this patient together and create that virtual multi disciplinary team that's at the platform level. But we also have people that are working for trellis, who are, for example, great coaches. So as Laurie will get into sort of the resilience. Space care is that we also have this touch approach because we want enhance the traditional care model where hospital brick and mortar, where you actually go and receive care and procedures. There's no doubt that is not going to change Our our goal is to be able to enhance that experience for both the provider and the patient and me, you know, and trellis and my experience in the IBD space. Bringing that to the clinician and saying This is where we think State of the artist today as it changes tomorrow or next week, we're gonna bring that right back to you. So you are always practicing IBD care as of what the latest and greatest is as of yesterday, right? That is a beautiful thing to be able to my opinions as an educator to be able to provide and be ableto let them know using some of our tools which patients are at higher risk of developing complications from IBD itself from the disease, which often leads to higher cost, could be tied to more disability, lower resilience, which I'll let Lori allude to white layering on resilience to the underlying biology of the disease itself and that interplay between emotional well being, inflammation and disease control. You can't do them in silos, which is how it's happening right now. So maybe Laura, you can talk about how your experience has been where you integrate a layer of resilience into an underlying biological sort of process. Yeah, that's great. So right. So, as Marla said, we really can't dichotomies these two issues mental and physical well being. And and we really are fully taking what is meant by the bio psychosocial approach, right? So we're including the biology in the psychology, and we're making sure that patients are equipped to deal with their disease across that the mind and the gut in particular are very interconnected. Eso is certainly for IBD, but as for other diseases as well down the road, Brasiliense, that bio and that's like ecology are going to be really important. One of the things that we offer when we focus on resilience, space care is the concept that you don't have to settle for a life that is somewhat less than because you have a chronic condition right And so many of our patients aren't walking around saying I'm depressed. I'm anxious. I have PTSD. They're just saying I don't really have hope for that job promotion. I don't really have, you know, clear goals in my life anymore. I've lost my way because this condition has really interfered with my ability thio to thrive and be who I am. And so over the years we've come up with some very specific targets that equal resilience, that we treat thio in our in our program, things like, Does the patient have optimism and hope that they're going to get better? Optimism is learned. It's modifiable. Does the patient have social support that buffers them against things that go wrong? Can the patient regulate their own distress when they are going through hard times? What kind of skills do patients need? Are they confident they know how to swallow that pill? Do they know how to talk to their employer about their condition? What kind of skills can we teach them? Thes air, all very actionable modifiable characteristics that we believe patients have those targets and we treat them to target on day are resilient than whatever comes their way throughout their lifespan, they will be able to rise to the occasion and handle it. In. Our program at Sinai was called grit, gaining resilience through transitions because the idea is that when people are faced with the next transition in life, it's an opportunity for them. Thio learn some new skills, figure out where they're going next. We want the sky to be the limit with our patients. And by having this resilience model, this transition model were always monitoring what's new in the patient's life. What skills do they need? Do they need more hope? We're able to really, um, parallel what's going on with their excellent clinical care and in conjunction with their clinical care. And when we do that, we were able to see significant improvements in quality of life, their well being but also and this is sort of you know, why Trellis has taken off. I think we've been able to show that we can actually reduce the health care costs of the disease when patients are resilient. I mean, you both shared a ton of very valuable and informative you know, elements of what makes trellis up. How do you feel that these aspects differentiates Ellis from other digital health solutions out there or really anything else that's out on the market for chronic conditions. Yeah, I think you know, we've seen through. Obviously, Cove in 19 has changed a lot of the way we're looking at how to deliver good care right in in through the through technology. And so I'll take the diabetes space, which has a lot of players in it. Um, and probably one of the more well known would be Lubanga. We work at Sinai with LaVonda and our pop health to deliver good care to diabetes patients, for example. And it's it includes device and monitoring your hemoglobin, a one C, which is a target. So the idea being is that if you reach a certain target, then you will improve your work. Productivity, Reduce absenteeism reduced present T is, um you know all the things that affect how you do your day to day operation at work, for example, asking an employer partnering with employers to help keep your your employees at work and being the most productive they can and the most resilient that they can in their in their career. So but What's interesting is that a lot of these companies sort of partner with various solutions to try and have the entire package. They'll have an APP based sort of mental health program where if you're feeling stressed or anxious, or having panic attack or some sort of Pts scenario that you could go to this app and it'll help you, right? So just do some meditation mindfulness, which again is part of our of our playbook at some level in different patients. But it's not a one size fits all. Oh, you're all anxious. Go to this app, for example. It's not sort of personalized in terms of what kind of resilience driven playbook you need. Similarly, there is also the telehealth delivery or the platform at which you which patients and providers can talk within right, creating the platform for you to actually do some telehealth well instead of it being pieces again. Sort of means to me more siloed again. It's not one platform where all of this is feeding off off of We are not. There'll be a nap component because people want to track their symptoms. May want to get track there, be in touch 24 7 have access to our tools 24 7. There's no doubt there has to be an app component, but that's just sort of an addition to what we're really building. Is this platform for which we're all communicating right? One common space, as I noted before. So what we're trying to do is ensure that we have the platform set up where we could use telehealth within the sort of shall I say, the dashboard and the EMR right. It's all in there so that everyone is looking at the same thing and interpreting the same way, right? That is really important. And what I think is unique about us is that we're able. Thio have everybody in the care team all seeing the same thing. You may see it differently. You may not understand it. We may communicate to the patient about a certain lab or certain resilience mark or different than we would to the physician who may want more of an analytical or scientific way of saying this markers up. So we're able to adjust even the way we dialogue and our narrative with the different players. Patients could add who they want to their care team. So if they're one of part of the grit, intake is actually asking them who's Who is there sort of key care champion? You know who do you, who's going to help us ensure that you're sticking with your goal oriented plan, for example? And so I think what is really clear is that everything we dio is based on how connected we all are, right? So that connectivity is now. We have three basic components to enable us to do on deploy trellis wherever you know. That's the point again, is that our platform, which is called Trellis, elevate the reason again, Lori mentioned the word elevate were very much about elevating everybody all stakeholders, right? We're elevating education. We're elevating the way we deliver care. We're elevating the way patients understand why certain therapies or certain playbooks are appropriate for them. This isn't go to the Internet and see what the latest greatest strategy for IBD or for resilience is. No, this is actually customized and personalized to them, specifically, which we see a lot of in clinic. You know, people will bring stories about I knew a patient who use this therapy, and I will have to say that that's different than your disease, right? Because IBD has multitude of different types. It's not just one we typically approach as a homogeneous disease, but there's over 250 genes tied to these diseases. So this isn't a simple one, you know, appoint solution. This is a similarly very personalized and and requires a lot of knowledge, which again speaks to why we're gonna elevate providers to be able to give them the same tools we use at the IBD Center or have built in our previous academic endeavors. Wherever we have built these tools and be able to offer them and stream them directly to the provider and the patients now getting to the personalization, what I think is unique about really is, as we think about how do you stratify patients? We can either say you're going to stratify them based on resilience. Yes, no, and you just do your playbook or you're going to just stratify them based on whether they're Crohn's or colitis is a high risk of surgery apparently happening. But nowhere has there been this integration of the two, so you're basically cutting a die economists outcome into four quadrants and we call Those are connective ity quadrants. And it's those quadrants which drive how connected the patient is to trellis and how connected they are to traditional care modules. You know how deliver like brick and mortar, as I noted, and how connected trellises with their character him. So there's multiple layers of connectivity that is all driven by our proprietary grip method, which Trellis has license to for not just IBD but other chronic conditions. So one of the things we always Lori and I like to say is we're building warriors, one patient at a time. But that goes across the spectrum of chronic conditions. Because IBD patients are not the only patients who are suffering from understanding how doe I thrive, not just survive with my chronic illness that I'm gonna have for my entire life. How am I going to approach the transition of motherhood, being a partner in life college, finding any job, There's always stuff right? You know, life takes a journey and the ability to go right through and propel forward rather than every time you hit what you feel to be a barrier. You sort of get stuck as opposed toe hop over it, and that's that image that we want people to also understand. And, of course, in order for Lori and I to get better in what we think drives and our advisors and all of our colleagues think drives risk prediction, either resilience or IBD prediction will come through our predictive analytics because we'll have a huge treasure trove of data that is staying internally with trellis, where we're gonna have patients. Help us understand how we can even be better. So we can then teach patients better, teach providers better teach the stakeholder all stakeholders care champions, payers so that we're all understanding this rapidly evolving field of chronic disease management, care coordination and how resilience could really change the trajectory of a patient. Yeah, absolutely. Thank you, Marla. I'd like to bring it back a bit to the mental and behavioral health aspect given this year, a global pandemic. You know, you spoke a bit about adjustment for patients, for everybody in the entire world this year, this year has been absolutely unprecedented. So in terms of Cove in 19, how has your how have your thoughts on resilience in general change because of co vid on How has that sort of adjusted your approach to in applying resilience to chronic Andi and more mainstream conditions? Yeah, that's a great question. I mean, I think if anything, you know, Cove in 19 has served almost as a resilient assessment for all of us. Right? Um, it is that trigger that we have to figure out all of us as a group how we're going to move forward with it, whether that is your own anxiety about the risk, whether it's the social isolation that it's created, whether it's the economic hardship, you know, pretty much everybody has been affected in some way that has forced them thio build their resilience. And so I think, more than ever we can talk about these concepts, um, in a very open way because we're all experiencing something similar. It's funny, like a lot of our I VD patients or like you know, I got this whole like social isolation thing. I'm used to stay at home in my bed and e know what it's like to be sick. Um, and so for them, they're like teaching some of the there, their friends and colleagues how to sort of set up their homes and, you know, they're taking their resilience and sharing it with others. And I think the same thing is true. You know, we've all adapted, you know, look at the resilience that Mount Sinai showed itself as a hospital. You know, on how we took care of our employees and our, you know, in the staff and our patients and how we transformed the IBD center into a tele health center within days of going from, you know, once the pandemic hit and we started to go to quarantine, there was almost no disruption in IBD care from the outpatient, you know, health perspective on DSO I think it shows that people are resilient and we talk about this all the time in trellised resilience is not a fixed quality or not either resilient or you're not. Resilience is a learn a ble, um, you know, buildable skill. And we're seeing it happen every day, Um, during the Copa pandemic. So I think it brings a lot of hope and optimism. Yeah, I mean, I think we all questions. I think of myself as a pretty resilient human being. You know, sometimes you need you need to be checked, you know, and need to understand. How do I sort of regroup and realize that all of us could be set back at any point in time? But it's the tool kit we have that gets us right back up. And I think that again is what is unique about taking emotional health and well, being in this positive psychology approach, as opposed to waiting and focusing on mental illness or mental condition. Right? We want to prevent that. You know, there are people. It would be harder to manage. Probably Laura, you can correct me if I'm wrong. Anxiety, depression. If you didn't have that resilience, right, so they're not. They can go together. It doesn't mean that you won't suffer from having anxiety or depression, but it's how those get integrated into your day to day lives and how resilient you are when you feel depressed or when you are feeling anxious, like Talackova as right. Yeah, and it's that growth mindset that we're really trying to create both at Trellis and during the pandemic of how do we grow from this? How do we move on as opposed to that fixed mindset of This is just how it's going to be, and there's nothing I can do. I'm helpless and hopeless. It's what can I learn? What can I do differently? Who can I connect with? How much more can I show gratitude to the things I do have in life? You know, What are those? Are the things that we are seeing people rise to? The occasion during Potvin, which I think is, you know, speaks to how resilient people can be if they put the effort in and learn the skills. And it's funny. I feel like you talked about optimism. It was always that that had our patients. I feel like there was an end, right? We were optimist. It wasn't stupid optimism. We weren't sort of just riffing about what you know what's gonna happen. Three idea that we actually were optimistic. That and I could tell the way patients are responding when I'd say, How are you? It's nice to see you. I know it was difficult to come into the city really proud of you. You were brave to sort of get through that. You know what was holding you back on bond? The concept that if I talked to him about what's going on or how we manage to that Sina or give them information. They feel really optimistic about their disease. And we were sort of lucky in that. I b d the community at large as a global community got together to get information really quickly to our patients, and Sinai was lead with University of North Carolina. So we did take a huge lead globally. By the way, um created a co vid registry, um called secure IBD and basically worked with at a global level to sort of give information. I've never seen something so quickly the built and deployed to give IBD patients information real time about how their therapies and how and be available using your telehealth platform war and be able to be available in real time. That's the beauty about the digital spaces. There is this. I need your help now, not go find a referral and let me know when you see them and let me know what the waitlist is. No, we're going to be available and we take that fundamental philosophy to trellis. Yeah, great. And you know, it's it's just inspiring and encouraging to hear that anybody can build resilience. It is a buildable skill. And it's something no matter who you are, you can you can create it. You can manifest it for yourself with hard work. I find that aspect simply inspiring, uh, sharing that. I'd like to get into a little bit about the commercialization process and developing something at Mount Sinai. How did you How do you feel? A Mount Sinai Innovation Partners worked with you to advance these efforts and ultimately developed trellis. Yeah. I mean, both Laura and I feel the same way is that there was no way we'd be here having this discussion with you if it wasn't for M S I p on DSO. Sometimes you know, part of leadership is seeing something you don't even see and taking you there. And that's sort of where I feel that that happened with Eric Liam and his team. Bill Chang in particular, who really helped, um, sort of shepherd this forward. It's been a work in progress. Nothing. Just you have an idea, and then all of a sudden it's cooked and baked and out you go. So they were clear on sort of what Laurie and I needed to do and what processes. And it all started really, with us being part of, uh, being incubated at Sinai and and talking Thio sharing our story, working with, um, sort of young entrepreneurs or new startup organizations creating slide decks, interviewing people, get out of the building three I Corps program and get at teaching us to get out of the building and even see whether your ideas interesting. It may be interesting to you because that's of course, Um, that's why we're passionate about it. But do other people get it? Is your story too complicated and easy? Is it a point where you know you've cooked it enough that it's now ready to be delivered to other people? And that's really what's happened over the last a couple of years. Last year we also presented our our startup and had people in the audience who were interested, and it gave us an opportunity to see what the focus is, uh, in particularly digital health and and entrepreneurs. And then through already, um, the M s. I P helped fund some of the grit prototype, which is trying to make seeing how that interaction digitally not just analog pens of paper like we dio every day at Mt. Sinai. They helped us, you know, with legal support for protecting our I p of course, and N d A s and C d a. Constantly with everyone. We were talking to bouncing ideas off. And they really help facilitate even naming of our company branding initial marketing strategy. Um, they also most importantly, probably has helped to secure our seed fund. I mean, they got us in front of a team who had already worked with Sinai on another startup called Analytics, which has been very successful. And we wanted to sort of work with these kind of investors who understand unique offerings that are not me toos that aren't just another mental health app. For example. This is really a completely different paradigm of care. And they saw I remember I had, I think 15 minutes and 90 minutes later I'm still talking about the solution. So I figured that was a good sign. And then within a month, um, we were in London Eso It was a very quick sort of like once, once your story was clear and really without m. S, I p wasn't gonna happen, so we're eternally grateful. And that worked for us. Look, everybody has different ways of of taking their ideas forward. And for us, there was no way we were gonna do this without Mount Sinai. I think that's also a very distinguished distinguishing feature is Mount Sinai. Crohn's was discovered at Mount Sinai. How exactly are we gonna move all that? Do it over here without, you know, taking advantage of all the amazing resource is that the dean? Our chairs, M s, I, p, all of our collaborators, our colleagues Lori and I couldn't be having this discussion without the entire IBD center. So again, this is, you know, the village we built on, you know, at three IBD center and then being able to take it out, we couldn't have done it without Sinai. We couldn't have done it without leadership. Everybody from CEO CFO Dean chairs down M s I P. And it's because of them were actually having this dialogue. So Laurie and myself do not ever forget that concept of how we were able to get to where we are today. Amazing. That's great to hear my final question for you is what's next? What's next for Charles Health. What are you hoping to achieve in the next several years? Let's say, Well, it's pretty quick. We just you know, we're relatively young. We've been at this for a while, but obviously with co vid things got delayed were about toe secure seed funding. Pre co vid. Obviously lots of startups sort of put on hold, but we were very blessed toe have it come back into the forefront because it became clear the trellises needed more than ever. And our our investors saw that very clearly and reached us toe reached out to us two months after the pandemic and said, We need to get this out there. This is a need that needs to be filled. And so we were able to finally secure it officially about a month ago legally, for example, and so we're just starting Thio ramp up. Obviously our team hiring the key executives we already have hired our CTO our business operations, our CFO CEO I'm sorry Money Fiat, of course, who's been with us now for a year working with us to get this to where we are and then our provider engagement and patient engagement officers business operation. And now we've got to build a clinical team. And in this time, we've also secured key scientific advisers. Because just like we said about the IBD center at Sinai, we, both of us, couldn't have been here without the help of our colleagues and support. And being having them be part of a movement like trellis is really important to us. So again, we're not people who think we could do this on their own. We got this. No worries. Don't need any help. Don't need mentorship. We're got this. We actually understand that the value is in actually bringing people into our passion, who share the same passion is us and incubate even better ideas and taking the best global advisors around the world. This isn't just you know us or a regional issue. This is a global issue, and it, IBD is is is a global disease. It is increasing in Asia, for example, um, to a point where it's believed that there'll be a many people in Asia with IBD as there is currently in North America. So this is a evolving disease that is just going to get more complicated. So we feel our time is right and we're busy creating educational programs. Lauren, maybe you can speak to some of the cool stuff for building and the resilience side as well. You know, just basically in what are what our goals are is part of our seed. Yeah. I mean, we're really kind of setting up that platform around our resilience targets and, you know, making sure that that messaging to patients, that our goal is to make you thrive. We're going to do that by building your optimism and building your self regulation and building your social support. And this is how we're going to do what we're going Thio, you know, assess using our grit score, you know, where do you struggle where do your strengths, but where your limitations. How do we fill that gap? What do we need to do for you? We come up with a personalized care plan that is done in conjunction with your grip coach. Get tasks. We know that. You know, we know what you're working on and why you're going to succeed and, you know, really making sure that the patients are engaged and understand the broader goal of, um, and the broader outcome. So not just the lack of an emotional problem, but the thriving the well being that we really want them to walk away with on the platform. Yeah. So the cool thing is, is that by January we should be up and running and providing are connected Health solution, um, and partnering with, of course, customers to provide their whether it's their member, shall I say, whether it's employees or health plan members. Um, showing obviously, at the end of the day, our goal is to really be part of the value based solution of health care. No more sick care. It's about health care. We all agree we're all on the same page. And in order to deliver value care, you have to increase the quality while decreasing the cost. And that's essentially what we will deliver to our customers and improve the quality of care for our patients. Amazing. Well, thank you both so very much again for joining us today. This has been so valuable. It's amazing to hear about trellis and all of the hard work that you've been doing over the years to bring such such a necessary solution. for patients out there for IBD and all of these complex chronic conditions. I can't wait to see what happens with Trellis in January and over time. So I look forward to maybe having you back on the Livestream again at with a great update on I wish you both the very best of luck and thank you all for tuning in today again. Please feel free to continue leaving comments ask questions on. We can keep the conversation going. This recording will live as a regular LinkedIn post on the M S I p LinkedIn page. So you can access it whenever you like on DWI. Look forward to hearing from you all soon, So have a good afternoon. Everybody have a great day. Thank you. Yeah.