Hello, everyone, and thank you for joining us today. We are going to give it a few moments to allow others to join and we will be starting shortly. Good morning, good afternoon, and welcome. It's great to see a strong group of leaders, partners, and stakeholders joining us today for NCQA's fireside chat. Rather than a formal panel, today's fireside chat is designed to surface honest perspectives of what's working, what's proving difficult, and where we see momentum building. We want to bring a practical and candid conversation to the table, one that goes beyond presentations and how our partners are working together for a better health care system. So let's get started. First, let's review some logistics. We will have time towards the end of the discussion for some audience questions. Please enter your questions in the Q and A function in Zoom. We will get to as many as questions as we can. And for those joining the conversation on LinkedIn Live, welcome. Jump into the conversation using hashtag NCQA fireside on social media, and be sure to tag us in your posts at NCQA. We will also be sending a recording of the event and any supporting materials to all who registered and posting a summary on our blog. Now I have the distinct pleasure of introducing our moderator for today's fireside chat. Christine Toppe is NCQA's vice president of state affairs, where she leads strategic engagement with state governments to advance policies that drive quality improvement and meaningful evaluation of population health and health care systems. With over twenty five years of experience, Christine is a recognized leader in health care performance measurement and accountability and was appointed to two California health committees to recommend health equity measures for managed care plans and hospitals. Christine leads state affairs nationally, focusing on policies that promote transparency and improve outcomes. So without further ado, Christine? Thanks, Amy. Welcome, our guests today. We're excited to have a new part of our health policy community, the a member of the state legislature with us today, and I'll introduce her in a moment. But as a reminder, for those who have not participated in our fireside chats before, this series brings together health policy voices from state and federal government through through the lens of measuring quality and improving health care, which is NCQA's mission in the space. So with that, I'm here today with Tracy Brown May, a Nevada state assemblywoman who leads the Assembly Health and Human Services Committee, where she advances state policy on health care access, quality, and social services with a special focus on maternal and child health and cross sector coordination. Her public service includes leadership roles on Nevada's advisory board on maternal and child health and early intervention policy efforts. As a national, at the national level, assemblywoman, Brown May helps to shape health care as co chair of the National Conference of State Legislatures Health Innovation Task Force. Professionally, she serves as chief administrative officer of Opportunity Village, advancing services and supports for individuals with intellectual and developmental disabilities. Welcome, Assemblywoman Brown May. Thank you. Thank you so much for having me here today. We're we're thrilled to have Thank you so much. It's really an honor. I'm excited. Yeah. A little bit rusty. Let's just jump back into what is a fireside conversation look like today. So thank you, Christine, and the rest of your team for hosting me today. Absolutely. We appreciate you joining us and talking about your role in Nevada, both as part of the state legislature and and what brought you to that service. So I think, you know, on that note, we'd like to jump in and ask you just some background on, like, what drove you to seek office and perhaps a highlight from the time that you've served so far? Thanks for that. The the question is asked often, right, to, I think, every legislator I've ever met. Why why did you why why do you wanna run? What do you think you want to do, and why why are you qualified to do it? I I had the honor of serving in government affairs for about fifteen years at a nonprofit organization whose sole focus was serving people with intellectual and developmental disabilities. My role there was not only public policy that affected the dis the disability population, but engaging the constituents that we served, right, the people who are seeking services and teaching them how to interact with their elected officials, local municipal officials, state government, our federal representatives. I can remember the first time I went to Capitol Hill in two thousand and five. I was an administrative assistant, and I took a person with disability and introduced them to our congressional delegation. They knew who we were and what we did, and I thought, oh, they we could actually move the needle here. Like, we people in congress are interested in doing this. Like, we could we could make change. And then, later, many years later, my local assembly seat opened up, and I applied for the job. I thought I could do I could do this job, and, that's when I went in in twenty twenty one. Yes. That's exciting. And I think a really productive example of where and how you can get involved as a as a member of your community all the way up, you know, beyond your your individual community. And and, obviously, we'll talk a little bit more about that throughout our discussion today. So appreciate that perspective because it's it's it's a good reminder and important to hear. So as the committee chair of the Assembly Health and Wellness subcommittee, what have been the biggest areas of focus for this upcoming session? Well, this interim committee that we're working on is really been about understanding the the number one priority, which is the HR one. Right? Some people call it the one big beautiful bill. We'll just call it the triple b. And what what are the implications? Right? And so when you look at it from a state perspective, and I know probably there are a number of folks here in Nevada that are on with us today. From a state's perspective, some of the changes in h r one that are being proposed are not really going to affect our state general fund. But how is it going to affect our greater community? And so how do we as legislators then dig into it? Right? Because hospitals will be affected. The nonprofits that are providing services will be affected. And whether that's just match dollars or that we're not able to draw down, you know, new grants or or other things. So HR one and understanding the implications of HR one is really a very big deal for us. The second piece that we're working on is really how do we build infrastructure? What does that look like? How to make sure that we are ensuring access to care across the state. We are at the bottom in Nevada of many lists. And that's sad and unfortunate and something that we continue to work on as a state. We're very rural. We are a territory. And so people don't realize that. I drive to the state capital. When I go into session, it's a seven and a half hour drive from Las Vegas, and there's only a couple of places where you can get gas, really, between here and there. And so it's important that we work on access to care throughout the state. The third thing we're focused on is workforce. How do we build workforce in our rural communities as well as our urban communities? Because we we still lack specialists. Right? We lack primary care. So how do we encourage folks to come here and deliver services? We've been working a lot on that through the interim committee. And then just the overall policies that improve health care. How do we improve access to health care? In the disability community, that's one of the things that I work on. If you spend a lot of time in one chapter of the Nevada revised statutes, you know the couple of words that you need to tweak in order to make the policy better. Those are the things that we're focusing on as a way to just continually incrementally moving the state forward. Yeah. The devil is in the details a hundred percent, and understanding that is is critical to your point in terms of having good and effective policy. Yeah. You've touched on a number of themes. Again, we'll probably come back to some of these. Obviously, workforce is a huge one. Rural access and the themes that go along with that in general. I mean, utilities, whether they be Internet or gas or you know, they're all really, I think, a fundamental part of the the larger access theme. And so, yeah, we'll we'll circle back to some of those. So, a big theme within all of the the activity related to HR one and other other federal policies is the Rural Health Transformation Fund. That's one of the things that we really wanted to dive into today. And for that initiative or that fund, states had to apply to funds for CMS to improve rural health access. And that was kind of a a compromise, if you will, with to balance out some of the reductions on the Medicaid side or or an attempt to. So we know that Nevada was awarded a hundred and eighty million dollars, and there were essentially four key pillars to the the application. Can you talk a little bit about the legislature's role in the oversight and design of the program. I think that's one of the things that excited me when I met you, was your, you know, very vigorous, engagement and excitement about about the legislature's, ability to support this. Thank you. Yes. I am very excited about the rural health transformation effort here in Nevada. While I said that we're at the bottom of many, many lists, it's my understanding that we're at the top of this list nationally for how we're doing the rural health transformation effort. And so we're really excited and very proud. From a legislative perspective, I am excited to work alongside our state divisions. Right? And so I my day job one of the things that's unique about Nevada is that we're a part time legislative body. So I have a full time day job. In my full time day job, I'm running a nonprofit organization that is working with the state. So I know how to build the state as a provider. Right? And so there's a unique perspective with many of us who have dual relationships within the state. Okay? So when you have a deeper understanding and you're actually the person that's executing the policy that you're creating, right, and then the billing stream, so then we get to work really closely with how do we develop solutions. That's the key part that I I am so appreciative that the state the team, the Nevada Health Authority, they're rock stars. Right? The Medicaid division, they're awesome. We have this really great transformational team who are interested in serving the population. They're passionate about it, and they're engaged with the legislature and the executive branch. So, largely, I'm here to support them and to help to champion what they're working on and to help to guide the conversation about how do we include the provider network. How do we include the the population that we're wanting to serve in these conversations? And they get it. So we get to work as a team instead of being oppositional. Now I will also say Nevada received nearly a hundred and eighty million dollars because we didn't quite hit the hundred and eighty million dollar mark nearly. But we're hoping to get over that hump in year two. Right? So that's year one. We're really excited to work collaboratively in this process, and the the state divisions regularly I have a regular meeting with them. Yeah. That's that's really refreshing to hear, and the that collaboration is so critical given, especially, the short time frame that really states have to be able to, you know, develop a plan and execute the plan and and, spend the funds because having a having a fund is amazing, but you have to have a plan to execute it in order to be able to make the most of it. And that sounds like a good problem to have, but it can be overwhelming too. So it really is a a great it's great to hear how productive the relationship is between the legislature and and the Medicaid folks. So let's dive a little deeper into the work underway in the state. So what is the hope in how Nevada's strategy for rural health can be sustained and how it can connect rural communities. Can you dive a little bit into that? Sure. Yeah. I spent a a lot of time last week with getting updated from the state division. Right? So we have this really core team that is working on the rural health transformation effort, And we have grand dreams. We have very big dreams for solutions. It and how do we deploy the solutions that are then sustainable? So we're really trying to be very thoughtful on where we spend our money. But then I'm gonna say, what we do in the first year, we're hoping to be able to continue in the second year, right, so when we get great success. It's a super cool, really grassroots approach that this team has decided to do. Right? And so the state is out asking providers how do they transform. Now no. I'm gonna I'm gonna go back on a quote somebody said to me. If you would've asked Henry Ford, what do you want? Right? Well, if Henry Ford would've asked the general population, what do you want when he was inventing the car, People would have said, I want a faster horse. Right? And so sometimes transformation, you have to get outside of where you are. And so being collaborative across the state has been really, really important. But to get the lay of the land in Nevada, you have to have there's a broad understanding. So here here, let me let me just share with you what what kind of this looks like. We have fourteen rural hospitals in Nevada. Fourteen. There are sixteen counties. Fourteen rural hospitals. Thirteen of those hospitals are considered critical access. One of them is rural but not considered critical access. Although, I I don't really know why, to be honest with you, because, I mean, they're all critical access hospitals. I found out, oh, two weeks ago that we have the most remote hospital in the lower forty eight states. Like, you have to take a helicopter from Ely, Nevada if something happens. It's that remote. And so when we come in for solutions, we have to listen to what those communities need, and every facility is different. So one of the things that I think the best part of this approach is that Nevada, our state, we didn't limit who could apply for the funds. We didn't say it's only for this hospital. It's only for these clinics. Right? We didn't limit it. And so everyone has access to the funds. We have dentists. We have ophthalmologists. We have hospitals. We have quick care. We have clinics. We have chiropractors. So everyone who is in the medical care, behavioral health, mental health, physical health, you can apply for funds, which is really cool. And so now we get to hear from all kinds of people about what do we need. What do we need? And our first round is flex funding. Right? So that's the really exciting part. We get to get into how do we modernize through flexible funding. Now knowing we can't supplant funds, right, you have to supplement, so you have to build out, and it can't be recurring. It can't be long term. So what's the one time funding you're gonna do to build out whatever your system is? It's very cool in that regard. So there's thirty six million dollars in this first bucket. As of last week, the state reported that they received a hundred and three applications for this first thirty six million dollar bucket. That those applications totaled a hundred and seventy eight million dollars. Right. Yeah. So we have a lot a lot of need a lot of need. And some of the requests are things like radiology equipment, room renovations. That one was interesting, like, the actual room renovations so you can bring in the equipment that you need. Right? You might not even have infrastructure to plug in the the new equipment. Right? Or you might not have broadband. So some of that. Ambulances, that was another big asks from what what I'm hearing, ambulances to be able to transport people. We even had a mobile clinic request. There are a couple of towns in particular, Goldfield and Tonopah. I drive through them on my way up to Carson City from Las Vegas, but they currently don't have any hospitals. And so how do we take a mobile clinic out? It's my understanding we have a dentist that goes out once a month or so. I'll treat people in that area. But so there's a lot of need throughout the community. That was first round is flex. That's great. And and do you wanna dive into the other elements? I don't wanna Oh, yeah. This is I mean, I think it's just fascinating to hear the level of detail because as you and I were chatting before, the applications reflect, you know, the plan and the description, but the but the actual you're you're bringing color to what's actually happening. Yeah. So, right, once we moved on and so this this Nevada team, this and and I'm gonna shout them out at the end because they're doing really, really great work. Right? They've been longtime state division leaders, and they're they've just jumped in and wrapped their arms around this really, really cool opportunity. The second so we're incrementally doing the applications and public meetings so that people can come in. So once we release the the request for applications, the RFA, the RFAs go out to the general public. Then a couple of weeks later, the state holds a public information session, and everyone who has questions can come in, and then the state will answer all of the frequently asked questions, work through all the the in the individuality of each of the applications, answer questions, and then help folks be successful in the application. So we're doing it incrementally, and the first round is the flex funding piece. And as I've said, hundred and three applications came in for that totaling a hundred and seventy eight million dollars in requests. The hard part's now gonna be figuring out what is priority and how do we deploy those dollars. The second round has a bucket of seventy two million in available funding, and it's focused on workforce. We've had a lot of efforts focusing on workforce in and around Nevada. There we've made investments in the past on graduate medical education, pipelines for community colleges, just how are we building the supports in the workforce. And so I can imagine there's going to be a lot of really diverse solutions to how do we build workforce. Right? Whether it's telehealth workforce, integrated workforce, education, funding for continuing education, building pipelines, all of that's gonna be really important. Our third round is rural outcomes, and it's budgeted at twenty six point nine million. And it's actually outcomes focused. So that is, like, how quality how are we delivering the quality of service? How are we seeing health improve in rural Nevada? And it's specific to each one of those areas. Right? So if you have a high diabetes numbers in one community, how are we addressing that and having a better outcome? If you're having higher accident rates in another community, right, how are we addressing the those health disparities? So every community gets to drive what is their health and how does it improve. So that's the goal. Yeah. Goal for the Can I ask can I ask you a follow-up on that one? Just I'm kind of curious. Are they are they submitting their respective plans for demonstrating that improvement? How how does that get organized? That's a great great question. So let's see. Let me let me go back and look at my notes. Yeah. It's a September. Okay. No. No. It's good. Right? It's good. And and I I I'm just gonna I'm gonna run through my notes really quickly. Right? Because that's really what it's about. It's about, direct patient care. And so the applications that will come out will address what is the health disparity they're looking to address and what are the proposed solutions because you need to know what that investment looks like. Right? Right. You can't just say I'm gonna address diabetes care. You have to have a plan in order to be able to do that. So Yeah. That's where we are currently. And then, of course, what's the scientifically backed information to propose that that will be a solution? So I'll give you an example. One, and is this probably gonna cross a couple of buckets, and we didn't get to technology yet. But, like, we did a tour with the National Conference of State Legislators and a provider, Phillips, who has technology that you can plug in an ultrasound into your iPhone. And so how do you get how do you so how do you improve the health care of pregnant moms? Right? And during prenatal care, what is that? So if you're having high fetal or maternal death rates, how are you addressing that? Would be an area of focus, and then you could come at it in that way. So outcome? What's the methodology? What are you proposing? How are you gonna increase your Right. Right. Bringing some of that technology in a mobile clinic or or planting it in in the community, to support those, providers for the variety of patient needs, but specifically on the ones they're putting forward. Very, very helpful. Yeah. Well and so then there might be other so, like, potentially, which let's get to the fourth bucket. Right? So the fourth bucket is rural health innovation and technology, and there are three tracks in that bucket. Right? Track one is core health and interoperability, safer cybersecurity, right, CMS, digital health ecosystem. Track two is provider facing, the digital tools that will help providers be successful. And then track three is consumer facing. So how do you have access to your medical records? Right? How are you how do you have better care as a better access for patient care? And so those three tracks in technology. So the example I gave you about maternal and infant health, right, could fit into the technology bucket, and it could fit into the rural health health outcomes bucket. So it could go into bucket three. It could go, you know, the third round. It could go into the fourth round. And so how then are we able to spread the the dollars around? Do know? Like that. Yeah. Yeah. No. That's, I mean, I think that that is a a really, critical point to emphasize in where we are in health care from an access standpoint, from a quality of care standpoint, and from a resource standpoint. And you really have to bring those perspectives all together to really design, or or plan for improving a meeting and then improving, you know, the health status of your community. And and on a in but, you know, diabetes is the one that comes to mind for many people in terms of, some of the tools available for remote patient monitoring and things like that. And and that's certainly a focus area for NCQA as we're evolving our evaluation programs around wellness and and recognizing digital tools. And so I appreciate you raising that because it is a a really critical part of the toolbox that, you know, that is gonna be necessary to really maximize the resources we have. And we know that providers, you know, from physicians down not down, across, across the the, the health care ecosystem are leaving. You know? We're having we're having issues with getting enough people to to replace those who are retiring or moving into administrative positions. And as and so I think that that has to be, you know, that recognition that technology has to be a part of the support in order to, ensure that p people are being monitored and can be treated and then obvious and and ideally, managed or improved. So this is a great, tee up for our the pivoting into our next we're not pivoting, but but continuing into the the focus on technology and and in the our our the rural health transformation and its emphasis on use of technology as well as the administration's focus on interoperability. And so, you know, I think states and the and the federal government, as I mentioned, NCQA and other stakeholders are really trying to support or determine what their role is in supporting, interoperability. And we all have a role to play. NCQA is a measure developer and, you know, the, kind of, the infrastructure behind how data are audited to ensure good quality. You know, we have a very, we feel like we have a very, important role to play in making sure that the data that flow through are of good quality and are useful, at the time of care and then for all other use cases like reporting and compliance and all of that. And so I think what I'd like to just kind of touch on and ask you about is how Nevada's current landscape is planning to use the funds around for you know, to address interoperability. Thank you for that question. That wasn't planned at all. Oh, boy. I wish I had that answer. Right? So interoperability is a thing that we're gonna continue to work on. We've had a number of conversations over the course of just my time in the legislative body in particular. Right? We are currently lacking a centralized system here in Nevada. So we don't we don't have a state state database where we can help patients be successful in that way. So there's been lots of discussions around that. We've had a couple of work groups. I think as we get into this discussion more and more, we're pointed to the state will have to be the guiding leader in how we're creating this health information exchange. Right? I can imagine that we'll have to have a state appointed board that are independent so that we can make sure that patients have access and specialty populations are involved and and providers are there and the insurers are there. Like, we have to have everybody at the table in order to build this out. Right? So it is possible that the rural health transformation effort will help us as a state get there because it would be a onetime investment in the infrastructure necessary to deploy? What does health information exchange and interoperability look like? We do have some folks that are that are choosing to work on certain platforms. Yeah. We're not there, and we have a long way to go. And so we're hopeful to help to build this out, but but it would definitely I I see it from a a state deployment. Yeah. No. I get that. And I I think one of the things that you often hear as just a human on the street when when you talk with people about health care and what's happening with data and in the world, there's there's kind of a question about, like, well, who has my data? Do I wanna have you know? And those are really important questions in this in this time where data is available to lots of different, organizations for different purposes. And so I I well, I wanted to ask you if you could share kind of your perspective on why this is important for the patient. Because we have our perspective, but I think it's really compelling to hear it from yours. Sure. Yeah. I I have a patient perspective. Right? There there's an interesting story. You could probably Google it, and it'll pop up in a newspaper somewhere. So the last time the governor did a state of the state address was right before we went into the last legislative session. And I you know, we have to fly up as legislators. I was legislators. I was not feeling great that day. Anyway, long story short, I passed out cold on the floor of the legislature in Nevada just before the governor came in to give his state of the state address. The governor thinks I did not want to hear his state of the state, so I just, anyway, it's a joke. It's an insight. And so I was taken to the emergency hospital in Carson City for diagnostic and treatment. And it turned out to be very minor, and I just didn't have enough potassium in my body. So for all of you out there, take your electrolytes. Okay? And so, yeah, I so I spent the couple of hours in a really great hospital in Carson City, Carson Tahoe Hospital. They took great care of me. They ran tons and tons of tests, and I I was discharged that night to go home, and all was well. So I am in Carson City, and I have all of my health records from all of the tests that this hospital has just done. And the discharge order was that I would go home and to my primary care provider and do a follow-up for additional testing just to make sure that my potassium level was stabilized. K? And so now I fly home to Las and I go to my primary care provider. And my primary care provider does not have access to all of those tests that were just done because the health information was not interoperable, and they didn't share data. And so I had data from one health care system in Carson Tahoe, and then I have data from, like, the primary care provider in Las Vegas. But nary the two shall meet. So I am pretty tech savvy. Thank goodness. And so I had installed the app from Carson Tahoe, right, and their health information exchange on my phone while I was there. So I could download all of my test results into my iPhone. So when I went and saw my primary care provider, I was able to show him all of the tests that were done in Carson Tahoe so that we didn't have to redo all of those tests. Otherwise, we would have started from scratch. So that doubles the cost of care. It slows down the process. Right? And so I think that it's really important that security of your data is super important. Right? Like, I don't want any random person to have access. But from a patient perspective, that was just one emergency room visit, which surely could have probably been an urgent care visit, not emergency. It wasn't life threatening. And then primary care provider. But now imagine if I had a cancer diagnosis, if I have a, you know, a a long term condition that must be regularly treated and I have to see multiple specialists, when all of that data does not talk and you have to go to multiple places, it just it slows down and costs more money to the to all of treatment. So as a patient, I don't get the best care because my my providers don't have great information. Yeah. I I think the other, policy note on that story is in addition to, you know, potentially wasted resources in terms of, you know, the spend of the of the second provider, it's also your time, your potential, you know, exposure to risk or or risk of something happening as in part of those tests that's unnecessary. And so it's it's it there's a lot of, care experience that I think is not even addressed in the discussion about the value of interoperability and the downstream impact on a patient in terms of not having to repeat all of the same information or or download it and be the interoperable link. Right. You know? Well and then what about when we still have doctors who send, like, discs? Remember the the hard discs that used to come in your computer like that? Like, you I don't even have like, I can't even read that now. And and I don't really like giving blood, like, honestly. So why do I want people to keep like, if I have to do it again and again? No. It's I don't like it. It's not good. So it's not a great patient experience. Yeah. I think I think everyone listening would, those those comments will resonate. So I appreciate you sharing that example because I think it brings it home, for those that are coming from the patient perspective and wondering, you know, what does this mean for me? What does this mean for my information, and why would I benefit from it? I think that really is a a critical takeaway. So I'd like to pivot from, you know, state health policy and rural health transformation and, dig in a little bit more to your specific, background. And, you know, as a as a longtime disability advocate, kind of how has, the work that you've been doing changed your day job? Oh, good. Thank you. I love the work that I do. Right? That is why I'm in the legislature. This amazing population that I serve, primarily people with disabilities, I think everything everything changes for me because of my experiences with this population. Primarily, just when you're out in the community, I can hear the way that people talk. I learned a long time ago to speak and write in sixth grade English because it's the most widely understood. I never wanna presume whether somebody is learning English as their second language or their third language or they're just learning English. Right? They may not have a college education. They may not understand. I think really important that would that we just are approachable and understandable, and I think that's a big part of what I've learned, right, really from this population. When I consider all of my policy, I look at it from the lens of people with disabilities, whether it's a physical disability or an intellectual disability, every policy that I run. But, moreover, every policy that comes through the legislature, I represent people with disabilities in that policy. Right? And so it's important that we have those constituents that are always represented. We don't always think about that. So I think that you being part of the community is what brings you into the legislature and then brings that population forward. That's why it's so important we have a diverse legislative body. That isn't that the truth? You really need all the voices to to hear you know, to to to create the the right policy for communities in the state. There's I mean, sounds obvious, but doesn't always play out that way. So, you know, I think your work is definitely something that, in the disability community, that that the, importance of organizations involved in contracting for Medicaid, supporting, you know, Medicare Medicare beneficiaries as well. Any anyone receiving, health care really needs to be mindful of of, you know, a potential disability, whether it's whether it's, you know, known or or or can't be seen. And so I think NCQA has been, focused on how best to incorporate in our programs, that that, important, not just population, but but, you know, the, whether it's perceived or die or or diagnosed disability, you're there there's a sensitivity that needs to be brought, to the health care experience. And we recently added some disability accommodation standards as part of our mandatory, data collection for organizations that are coming through our health outcomes accreditation, and and we're really hoping that these updates inform the care experience of providers as they're going in to meet with patients perhaps for the first time or perhaps for the first in a in a while, you know, as they're as they're as they're approaching that with potentially a new perspective. Just curious if you have any thoughts about that. I think that's the coolest thing ever. Right? Yeah. That's really a great a great way to enter into it. So twenty five percent of our population now identify as having a disability. Twenty five percent of Americans identify as having a disability. And so some of them are disabilities that would reach a level where you would want a funded support service like the one that I do under a Medicaid waiver, and some of them are just a disability that a person is navigating but may need extra attention. Right? And so the thing I learned is when when you've met one person with a disability, you've really just met one person with a disability because everyone is so unique. Right? Yeah. We have to keep that in as we build solutions to those policies. Yeah. Absolutely. Yeah. We're we're it's been a hard journey. I I'm not gonna lie, you know, because there's complexity, because of the ways in which individuals either self identify or or formally identified as having a disability. And so, you know, those complexities and that sensitivity around that is not lost on NCQA, and we're we're, you know, trying to help our organizations that come through our programs navigate that. And we appreciate the support and guide guidance from from experts like you, you know, to to make sure Right. Christine, one of the things that will pop up for us in particular is that there are oftentimes I shouldn't say often. It's not uncommon for a person to reach adulthood and not know that they have a diagnosis. Oh, interesting. The in the population of people with intellectual or developmental disabilities in particular, sometimes families don't share that because they don't wanna limit a person's perception of their own ability to achieve. Right? Of course. And so I have seen people who be like, are you talking about me? That's not me. I don't have that diagnosis. And they've come through their entire lives with whatever that diagnosis was. It's very interesting. And so, also, how do we not limit a person's perception of themselves? By putting a label on them, that's also another consideration. We have to give to that. I appreciate you calling that out. It's definitely a factor in all of this. To your point about, your your own ability to achieve your maximum, you know, success as you define it. Right. Well, often when I talk to large groups about people in in the disability community, right, I ask them if they have a diagnosis. Do you have a diagnosis? And does that diagnosis define you? Right? It doesn't it's not who you are as a human being. It's no different when you're having intellectual or developmental disability and you have a diagnosis. Down syndrome is just Down syndrome. It does not identify your ability to be productive as a human being or have before you. Right? Right. And so we have to be careful that when we have a diagnosis, we don't allow the diagnosis to define who we are or what we can do. Yeah. I'm curious. You know, what do you think the areas are that are kind of commonly overlooked when advocating for a better health care experience for people with disabilities? Oh, that's really good. I think it's all access. I think that understanding you heard me talk about grade English. Right? It's really important that we are allowing people to understand what's happening. And so I don't think that I think when we build systems for people with disabilities, we build systems for everyone to have better access. Right? Is it the least among us or those who are last shall be first? Those who are first shall be last. Right? So if we take the last, the least among us, right, the least at the front of the line, and we help them get to the front of the line, we've helped everyone before them. Right? And so I'll give you a couple of examples. We see people with disabilities everywhere, but we don't recognize them because it's not relevant to us in our own personal story. I see people with Down syndrome or an intellectual disability diagnosis everywhere. I see them everywhere. They're throughout our community. And they're my people because I've served them for twenty five years. Most people would walk right by and not recognize that there was a person with a disability there, and you don't talk to them. Like, I don't walk up and introduce myself. I don't make it weird. But, like, I can recognize that they are a large part of our population, that that these amazing people are part of our population. When we build systems to help people have access, we build a better system for everyone. So I ride a bike. Somebody pushes a baby carriage. A curb cut infrastructure, a curb cut on a street or a sidewalk was made as an an ADA disability accommodation. But my bicycle has better access. Your baby carriage has great access. People don't have to step up and down. Right? So the entire community benefits by an ADA accommodation, which is not really an accommodation. It's just really good access for the whole of the community. It shifts how we think about how do we have access. Yeah. What about automatic doors? You go to the Target, the Walmart, the Nordstrom, wherever you shop. Right? You have automatic entry doors. That's an eighty day accommodation. But how cool is that when you walk out with a bag full of groceries or, right, a cart full of groceries? You don't have to open a door. All of those automatic doors. That's all ADA accommodation. We just don't recognize it as an ADA accommodation or some infrastructure that we built into federal law or expectations in development. It's how we know people have access. That's so fascinating. Those are really good examples and really make sure you open your eyes to all of the things that we take for granted in our own lives and that we as we don't. I would never have made an assumption about the automatic doors. How about this? What about that? What about your iPhone? Your iPhone. That's just the greatest accessibility tool. Like, Oh my gosh. If you you need closed caption, I can load an app that does closed captions. So, like, I my I can hear the guy in the movie theater. I can hear right? Like, I can put things and tools on my phone that give me greater access, and every one of us carries this around. We all use it differently. Right. Now that's a great point. That's another really good point. And so having access to those things, those technologies to allow independence is is really can be a game changer. And all of your medical app. Like, I have the health app. Right? So I could check my oxygen level. I can check my right? Like, I track my weight. I track my exercise. All of that is health information on my phone. You are the the poster child for maximizing your tools. That that's phenomenal. That's phenomenal. Well, I wanna make sure we have a a little bit of time before we close out. Are there other topics that that you'd like to bring up, you know, just before we close out today? I wanna shout out Nevada. I do. I wanna shout out this amazing team. Right? This is not me doing this work. This is this is the the great team that we have in Nevada that's doing this work. Stacy Weeks is leading the way with the Nevada Health Authority. The Nevada Health Authority is brand new. We created it during the last session of the legislature. We separated the division of human services and the Nevada and Medicaid and Nevada Health Authority, and we made two new wonderful peer divisions. Stacy and her team are doing some awesome things, and I'm so grateful for her leadership. Right? Anne Jensen is leading Nevada Medicaid. I see her everywhere. She is so warm and open to hearing from everyone across the state. Her leadership is just phenomenal, and so I'm grateful for her. And then this amazing team that I've worked with, right, that specifically on the rural health transformation effort, Melinda Southern and Jason Bleak. Right? They're the they're leading this effort. They're the ones that are out working on getting the information out. Melinda's the the deputy director for the Nevada Health Authority, but she's the one re leading this rural health transformation, and Jason is the agency manager. And they're sharing their work to date. They're so excited about serving Nevadans. This collaboration is really the biggest part of what we do. Right? Like, as a legislature, I can help to move the needle with regard to Nevada revised statutes. They're the ones that are creating the Nevada administrative code based on those statutes. Right? And they're having to work with the executive. We have a Democratic majority legislative body. We have a Republican governor, and we have our state leaders, right, the bureaucrats that have been with us. And don't say that as a dirty word. I think bureaucrats are amazing. Right? Like, they're the ones that show up that do the work of the bureau and the divisions. Every day, they're dedicated leaders in our state, and we can't forget that they're there. They often work for less money than the private sector, and and they're doing it because they love our state and they love the population. And so I just wanna make sure they know how much I appreciate them as leaders in our community. That's an important shout out. They are definitely doing some heavy lifting certainly now. This is, you know, a a very busy time, and and everyone's drinking from a fire hose. So it's it's important to recognize the good work that they're doing to try to improve, you know, the care experience of folks in Nevada. We have, let's see, no chat questions yet. So I think I want I wanted to close out with you while we're waiting for some questions with a piece. Like, what advice would you give to our our audience, both the ones that are live today and the ones who are gonna watch this, in replay? You know, for the for folks that wanna get involved in state and local government or their community organizations, what's your what's your your takeaway for them? Do it. Do it. Don't wait. Do it. I I loved being a part of the system as an advocate and a facilitator helping people learn about government, right, and just civics. So many people just don't even understand how government works. Right? We're all just people. We live in our community. So if you're interested, jump it. Don't wait. Find a way to do it. Local school boards, right, are great places to start. The first thing I ever did, my first elected position was as the president of my homeowners association. Now I wouldn't necessarily recommend that, but I'm just saying, like, it's a great way to start. Jump in. Do it. You can affect policy at every level, every level. Right? It's really important. Yeah. The other part I would say is building trust. Right? Being consistent in who you are, build trust in your community. That's how you do it, and I think do it well. I hope that you've seen me as very authentic today. This is literally who I am. You're in my home office. It's about that. It's about being consistent and showing up and and building trust. But then also knowing that it doesn't matter if I have a d or an r after my name or if I'm nonpartisan. It doesn't matter whether what party I'm affiliated with. When we're doing public policy, we're doing policy for everyone. Right? I represent everyone in my assembly district. We're all on the same team because we're all working to build the policy that affects everyone in the state. And so that includes the executive, right, the governor in whether he's my party or not my party, the state bureaucrats. We we all have to lift each other up to success. And in this time, right now, it's really precarious that I'm I'm attacked on social media pretty regularly by people who've never even met me. And we feel as a society for some reason that we can just do that, and it's okay. But I don't think that's the majority of us. I think the majority of us all want success together and that we can do it as a team. So I would say if you're interested, first of all, you have to have a really thick skin. You have to be trustworthy, and you have to be consistent and show up. But don't wait. Do it. We need thoughtful leaders right now. We need you now. And no place is too small to start. Homeowners association, booster club, you name it. It's they're they're all, they're all learning environments, that that can give you that confidence to go to the next level. So Sure. Tracy Brown May, thank you so much for your time. You've been an amazing, guest on on this fireside, and I just really appreciate, the authentic self that you brought as well as your expertise and and the good work that you're trying to get done in Nevada. So thank you with that. I don't see any questions, but for folks that are interested, I don't know that we well, Tracy's contact information is public. We can provide that afterward as well. But with that, I will hand it over to my colleague, Amy, to take us home. Great. Thank you both, Tracy and Christine, for an engaging conversation today, and thanks to our audience for spending some time with us. A few closing reminders we'll just put up on the screen momentarily. While it's great to see everyone engaged and present online, we'd love to see you in person. On the screen here you'll see some spots our team will be at in the coming months. Our public policy staff will be at these events this summer, the National Association of State Mental Health Program Directors in July, NCSL legislative summit, which you'll also see Tracy, Christine, and I at in also July, and the Medicaid Enterprises System Conference in August, where NCQA will also be speaking. So feel free to stop by our booth or email us at publicpolicyncua dot org to connect. And then our final slide, thanks again, Assemblywoman Tracy Brown May for a thoughtful discussion and your work every day to serve all Nevadans. As a reminder, our audience will be on the lookout for a recording we'll be sending to you and a blog in the coming days. We appreciate your time you took today to listen. And if you can spare a few more moments, we do have a post event survey that will pop up in your browser as we end the call. Your feedback is valuable, we can continue to support and feature wonderful speakers like Tracy on our fireside chat series. So thank you all, and have a wonderful rest of your day.