PBC innovation through creating a new company

Posted on November 17, 2009. Filed under: Commissioner, News stories | Tags: , , , , |

Pulse | Focus on…..Social Enterprise | 17 November 2009

Dr David Morris and Dee Kyne explain how they remortgaged their practice to kick-start the process of PBC innovation in their area

When I came into general practice in 2000, I found it immensely frustrating that patients would come back time and time again with the same problems. Faced with a 20-month wait before they can do anything for them, their GP can feel powerless. And so we began to look for a way to have more control and to find a better, more efficient and more rewarding way of working.

Accessing the right person in the health service is difficult at the moment and often requires several steps. We wanted to create a service that would ensure efficient and streamlined access to the right person at the right time in the right place, and would take the surgery to the patients – rather than the patient having to come to us.

All change needs a driving force and models of successful innovation, but few are willing to take the necessary risks. PCTs tend to be risk averse as their priority is to make the finances balance. GPs often feel they should be insulated from risk and PBC clusters are often defined by geography rather than attitude to risk and willingness to innovate. The other 22 practices in our PBC cluster weren’t ready to take the next step. So we took it alone.

Setting up the social enterprise

We decided the best model to adopt would be a social enterprise so we could take the risks necessary for successful innovation, which others could then follow.

In 2006 we decided to establish a community interest company, which we called Pathfinder Healthcare Developments (PHD). We decided on this approach so that we could access funds and prove we had a strong governance framework. We reinvest our profits and assets for the public good. The idea was initiated by Dr Niti Pall, a partner in our practice and PEC chair at the time, and took about a year to develop. The company started in 2007, then took around nine months to really take off. The company is now owned by the practice along with business development director Dee Kyne, who was brought in to set up the social enterprise. The company was initially run separately from the practice. It now covers three practices.

The 11 partners invested £34,000 of their own money (about £3,000 each) to start the company and support initial staff salaries. As the company has grown, it has been able to pay the current 12 staff salaries out of its turnover.

A further investment to fund redesign of our primary care services came in a £200,000 loan from the Big Issue Invest – a fund that invests in groundbreaking social enterprise. We were its first health investment. The partners took the risk of underwriting the loan by remortgaging the practice premises.

PCT involvement

At this stage, our PCT, Sandwell, had not invested in the company. We started on a programme of redesigning our services using the £200,000, focusing on preventive care and early intervention, which is where we will eventually make the most significant savings.

Once the PCT could see what we were doing, it came on board and in various ways has invested around £400,000 of its own money. It has paid for us to run the community aspect of its CVD programme and contributed to the risk stratification analysis (see right) and workforce development for both clinical and non-clinical health professionals across the cluster. (We had already funded this with some £25,000.) The PCT invested a further £35,000 to develop a supervision and medical mentoring programme for the cluster.

Some of the money has also come from the PCT’s innovation fund. It is very supportive of what we are doing and has given us almost total freedom. The social enterprise has put us in a strong position to bid for contracts such as PMS Plus, APMS, LESs and DESs.

We work with the PCT collaboratively – we don’t have to ask for permission. It’s a healthy relationship – the innovators push the agenda and hold the power because we are the providers and we are very close to the patients. A PCT is more restricted in this area because it is trying to be a good banker.

PBC involvement

Although PHD has no immediate direct link with PBC, we’re using the practice development as a pathfinder-incubator company for areas in PBC. What we’re trying to do is linked very clearly with the set aims of PBC: improving primary care access, moving more services to primary care and minimising unnecessary use of secondary care.

Having an incubator company in the cluster enables us to test innovation. We have taken huge gambles to see if we can restructure the way we offer primary care services. That then becomes available to the PBC cluster and sets the tone for what may be achieved as a collective. Others in the cluster have access to everything we’re achieving, such as IT innovation and risk stratification of the managed population.

Data

We have worked with Aetna, which is one of the Government’s Framework for External Support for Commissioners (FESC), to develop a robust risk stratification tool.

This uses primary and secondary care data to establish how our patient population is at relative risk of becoming unwell and allows us to become a very effective health population manager. This is being used though the cluster and is supported by the NHS Evidence Centre.

The data has dispelled some myths about how our patients access healthcare and has shown us the areas we need to change.

For example, when we started out we believed diabetes and mental health were our ‘low-hanging fruit’. But when we risk-stratified the population, the high spenders turned out to be asthma in young people and people who had two or more long-term conditions. Interestingly, the latter group was any combination of any two conditions. So we realised that no single condition drives urgent admissions and therefore that care management that focused on specific disease areas would not meet patients’ needs.

This information showed us the way forward and led to the development of a model of work that will ultimately reshape services to the benefit of everyone.

Our aims became:

• to redesign services to improve access in primary care

• to keep people well who are currently well and reach out to those we don’t normally see

• to maximise the health of those who do have illness in a targeted way, focussing on those with more than one illness through a care management programme

• to develop staff and personnel in a very positive way

• to provide value for money – not just providing cheaper services but making sure costs aren’t multiplied by ensuring patients are seen by the right person at the right time.

The service redesign model

The service redesign model we have developed comprises various elements, as follows.

Self-care

We are developing personal care packages, working with people in their homes and looking at how technology can help them.

This service promotes confidence in self-management and provides an opportunity for community members to develop skills that improve the health of others in the community. We are also exploring using telemedicine.

Outreach/inreach

Working within communities that have not until now been contacted proactively, for example church communities, Gurdwaras, mosques, pubs and shopping centres.

We have carried out mid-life health check sessions in supermarkets, connecting with more than 500 people. By actively looking for patients at risk of ill-health this service will reduce inequalities in health.

On behalf of the PCT we carried out the community aspect for the CVD programme. We were so successful in engaging members of the community that we now have a 45-strong volunteer force who have become health champions. This has rolled out into the cluster and is now operating across the whole of Sandwell.

This group now forms the bones of a patient reference group, which will be an important part of everything we do in the future.

Fast-track referral and treatment

We have triage and clinical assessment teams working closely together to ensure people are no longer slowed down by the system. Clinicians and support staff are streamlined into effective multidisciplinary teams.

Signposting

This aims to identify all the resources locally that can help to improve people’s health – whether this is simply identifying a local ramblers’ club, or putting someone in touch with the Citizens’ Advice Bureau to discuss housing needs.

We set out to bring together the information on a single website to make it as up to date and easily accessible as possible. We anticipate it will go live at the beginning of 2010.

Group consultations

This is a new style of consultation, for practice staff and patients with long-term conditions or recurrent acute conditions, delivered at the practice. It means a reduction in the use of primary care resources as well as better use of the most appropriate clinical expertise.

Diabetes and asthma group consultations are now a part of daily life at the practice. We will be launching other groups shortly, including back pain and hypertension.

Outcomes

Our model uses primary care as an agent of regeneration and raises expectations in a community that traditionally has low aspirations.

At this stage we are creating our own freed-up resources through redesigning primary care so we can then focus on innovation in secondary care redesign with our secondary care colleagues.

We have seen a slight reduction in non-elective procedures but can’t at this stage say it’s because of what we’re doing. We are now 13 months into our new way of working and all the financial modelling we have done suggests that by year five we will have made a saving of £40 a patient – £400,000 for a population of 10,000 through keeping them out of secondary care. The big win is that this money will be reinvested into NHS services.

We have taken this risk to get us where we need to be for contract reviews. We now have the power to negotiate and develop services. If we’d taken no risk we wouldn’t be in that position.

What we get from this is autonomy – developing the level of services we believe we should be developing.

The future

We talk in terms of becoming a health management organisation that would manage the whole of the patient’s capitated budget – the natural evolution for PBC.

We would like to call ourselves a social

HMO and bring together a lot of the social public health services that impact on our patients’ lives.

We are working towards holding our own budgets to provide outstanding excellence in primary care, with full control over the health economy spend of the patients we have responsibility for and delivering that as effectively and efficiently as possibly. We will take on the real budget risk with the PCT.

Once we move into a more sophisticated system of earned autonomy we intend to set up an effective discharge-planning programme and support service.

Dr David Morris is a GP partner at Smethwick medical centre, West Midlands, and partner in Pathfinder Healthcare Developments

Dee Kyne is business development director of Pathfinder Healthcare Developments

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Aetna UK

Posted on November 11, 2009. Filed under: Commissioner, Social enterprise | Tags: , , , |

Aetna UK | accessed 11 November 2009

Aetna UK is dedicated to supporting PCTs and other commissioning authorities to improve patient outcomes and reduce overall costs. Aetna UK combines UK-based operations with U.S. expertise in order to customize solutions for its clients.

Being ‘commissioners’ ourselves, we truly understand what it takes to maximise health gain within available resources. We bring significant breadth and depth of experience from the U.S. and are well-positioned to deliver a differentiated perspective.

Aetna UK is part of an on-going expansion of Aetna’s international businesses, with London serving as the operations centre for both commissioning services and Aetna’s UK, Europe, Middle East and Africa expatriate business. 

Vincent Sai is Vice President and Managing Director of Aetna UK and is based in our London offices. Meet the Aetna UK Management team

Aetna Corporate Overview

Established in 1853, Aetna has been a trusted name in American healthcare for over 150 years. Integrity, reliability, and commitment are key to everything that we do. We are experienced in commissioning services and offer a broad range of health management services and health insurance products.

We have relationships and contracts with more than 783,000 healthcare professionals and facilities in the US. Globally, we have relationships with over 740 facilities, including 90 in the UK.

Our clients include public sector and government sponsored programmes, employer groups and individuals. Consistently, surveys recognise us as one of the most ‘doctor-friendly’ healthcare companies.

Partnership is key to our success. We work with some of the most complex organisations in the world today and believe that success can only come by working alongside our clients in order to create customised, practical solutions to solve their healthcare needs.

For more information, visit www.aetna.com .

The Aetna Way

At Aetna we put the people who use our products and services at the centre of everything we do and live by a core set of values.

aetnaway

Customer Profiles

NHS South Birmingham

NHS South Birmingham and Aetna have entered a partnership — the first of its kind, to redefine how healthcare is delivered in South Birmingham. This unique public-private partnership brings together expertise from two world-class organisations that will share best practices to implement innovative programmes and services for the benefit of patients in South Birmingham. We are calling the partnership “Out in From Together” which sets the tone and direction for how we want to work — partnering to lead the way to improve health and health services in South Birmingham. Read our Q&A to learn more about the partnership and key areas of delivery. For more information about NHS South Birmingham, visithttp://www.southbirminghampct.nhs.uk/.

PUBLIC-PRIVATE PARTNERSHIP REVEALS INNOVATIVE APPROACHES TO IMPROVING HEALTH OUTCOMES

LONDON | 8 September 2009

NHS South Birmingham and Pathfinder Healthcare Developments launch two pioneering services to tackle urgent health needs and risks

NHS South Birmingham and Pathfinder Healthcare Developments CIC (PHD cic) have partnered with Aetna Health Services UK to develop new ways of working to improve health outcomes in their respective communities. These two partnerships demonstrate how public and private entities can successfully work together, and have resulted in the launch of two new services that support each organisation’s larger strategic initiatives.

The first service, a telephone care management programme, is a nurse support service designed to help patients manage their long term health conditions. The second, an online health risk assessment tool, gives people a picture into their current and future health status, and provides them with an achievable action plan to address their greatest health risks. Both provide the National Health Service (NHS) and General Practitioners with innovative approaches to managing health care costs while improving quality through personalised care and support.

NHS South Birmingham and Aetna have teamed together to redefine health care delivery in South Birmingham. NHS South Birmingham is transforming the way health care is delivered to their local population and developing skill sets that have a positive and long-term effect on the population’s health.

“This is an exciting opportunity to learn from a company who has proven expertise in delivering quality services, effectively targeting and engaging individuals and, importantly, managing cost to improve patient experience and give them more choice around health services and their individual care,” said Moira Dumma, Chief Executive, NHS South Birmingham. “This requires collaboration across all stakeholders, and our unique partnership with Aetna unlocks the potential within the health economy to share best practices, improve commissioning expertise and engage the entirety of our population, including those most in need.”

Pathfinder Healthcare Developments (PHD) is a community interest company operating as a social business. PHD has grown from an innovative partnership between three large inner city GP practices based in the Sandwell area. Their work with Aetna supports a larger project to implement innovative new practices, services and ways of working to support their diverse patient populations and the quality of primary health care services.

“Aetna’s bespoke approach to working is what is most appealing,” said Dr Niti Pall, Chair, PHD. “There was no ‘off-the-shelf’ solution that they tried to implement. Rather, they listened to our needs, worked with us to devise solutions and areas of support, and most importantly, co-develop solutions that were appropriately translated for the British market.”

Having both a primary care trust and social enterprise company engage Aetna demonstrates Aetna’s ability to work with different types of organisations, and how best practices from the private sector can be successfully translated to the public sector. It also points to a shift in the way primary care trusts and providers are thinking about delivering additional health services—and how they can jointly address the needs of their populations by utilising the experience of the private sector.

As one of the leading diversified health care benefits companies in the U.S., Aetna has been recognised for its advancements in medical management and health information technology. Recently, the company has embarked on exporting these innovations to support health care reform across the globe.

Notes to editors:

1. The online health risk assessment tool is one of the most comprehensive on the market available to the general public. Upon completing a questionnaire about health and lifestyle habits, the tool will generate a risk score. An action plan is also automatically generated that includes suggestions on how to address current health conditions and also reduce or even prevent future ones. Additionally, the tool offers “healthy living programmes” that can be taken online to address individuals’ immediate health needs. Among the included programmes are “Stress Relief,” “Get in Shape,” “Cancer Fighting” and “Healthier Diet.” South Birmingham residents can access South Birmingham’s bespoke tool by registering on http://www.sbpct.nhs.uk; Patients of Smethwick, Hollybush and Cape Hill Medical Centres can access the online tool on http://www.smethwickmc.co.uk/.

2. Over 17.5 million people in the UK have a long term condition (Improving Chronic Disease Management. Accessed December 4, 2008 athttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214), 45% of which who suffer from more than one. For patients with more than one long term condition, health care costs are six times higher (DeVol R, Bedroussian A. An unhealthy America: The economic burden of chronic disease.The Milken Institute. Oct 2007.). 80% of GP visits relate to long-term conditions. The steep rise in diagnoses of long term conditions and increasing costs for providing care for these patients are forcing a change in the way that commissioners and GPs provide health services in such a way to help manage rising costs while still providing excellent and quality services.

3. Aetna’s care management programme is a telephone-based support service for patients who have two or more long term conditions. Delivered by registered nurses, the service provides patients with additional support to help change their health outcomes by changing their health behaviours. Powered by Aetna’s leading data analytics and informatics tools and backed by an experienced clinical team trained in motivational interviewing techniques to deliver highly personalised care, the service aims to close the care gap by connecting patients to resources to support their journey to a healthier lifestyle.

4. Aetna is a leading health care company, commissioning services for approximately 37.2 million people worldwide through a broad range of health management services and health insurance products. Aetna has relationships with more than 1.3 million health care professionals around the globe, demonstrating the company’s commitment to providing customers and individuals with access to safe, affordable, high-quality health care. Building on its more than 150-year history, Aetna is recognised for its dedication to cooperating with doctors and hospitals, employers, patients, public officials and others to build a stronger, more effective health care system.

5. Aetna UK was established in early 2007 to offer dedicated commissioning support services to Primary Care Trusts (PCTs), and was appointed to the Framework for procuring External Support for Commissioners (FESC) later that year. In 2008 Aetna was appointed to the Practice Based Commissioning (PBC) Development Framework to provide support for PCTs and PBCs to help them strengthen and build on local support arrangements for practice based commissioning. www.aetna-uk.co.uk

6. NHS South Birmingham commissions services for a population of 383,000 people. Currently our Primary Care Services include 65 GP practices, 170 General Dental Practitioners, 71 community Pharmacies, and 80 local optician premises including domiciliary services. We try to keep health care close to home and offer a range of nursing and therapy services to support this through your local GP. We look at the health of the entire local population and address issues specific to our area. Public health is an important role and includes issues such as poverty, obesity, diet, exercise, smoking and other factors which impact on your health. www.sbpct.nhs.uk

7. Pathfinder Healthcare Developments (PHD) is a Community Interest Company (cic) based in the West Midlands concentrated in the Sandwell area. PHD is a progressive and innovative provider of extended primary care services, specialising in meeting the needs of inner city multiracial populations. It currently provides a wide range of services to a population of just over 25,000 across three practices and three sites through a Personal Medical Services (PMS+) contract and an Additional Personal Medical Services (APMS) contract with PCTs. It has a track record of delivering high quality services, often leading the way locally in the development of services, particularly to marginalised groups. PHD has a track record of excellence (recognised by the UK Department of Health) often leading the way in the development of services, particularly to ethnic minority communities, and to marginalised groups. The UK Department of Health has recognised the standards we achieve and the innovation we apply. www.path-finderhd.com

AETNA APPOINTED BY DEPARTMENT OF HEALTH TO THE PBC DEVELOPMENT FRAMEWORK

London | 2 December 2008

Appointment brings together expertise of Aetna, PricewaterhouseCoopers and the Royal College of General Practitioners

Aetna (NYSE: AET) announced today that it has been appointed by the Department of Health as one of five suppliers on the Practice Based Commissioners (PBC) Development Framework.  The goal of the Framework is to promote excellence in practice based commissioning by supporting the development of core competencies within PBCs and Primary Care Trusts (PCTs).

“Practice based commissioning is a critical element to achieving world class commissioning aspirations.  We are delighted to be recognised as a leading player in such an important area,” said Vincent Sai, Vice President and Managing Director of Aetna UK.

Recognising there is no “one size fits all” solution, Aetna will team up with PricewaterhouseCoopers and the Royal College of General Practitioners (RCGP) to deliver development services.  The breadth and depth of this relationship combines the perspectives of one of the world’s largest commissioning organisations and health analytic experts; one of the world’s leading change management and organisational development consultancies; and clinical insight and leadership from the largest of the Royal Colleges. 

“The unique combination of skills of Aetna, PricewaterhouseCoopers and the RCGP also reflect Aetna’s commitment to bring the best resources to support PBC development and foster continued improvement and innovation within the NHS,” continued Mr Sai.

Services offered range from building analytic and commissioning skills, organisational and leadership development, to improved engagement of key stakeholders including clinicians, patients and the public.  Ultimately, the value that the partnership brings is its experience in creating bespoke solutions that can help PBC consortia prioritise and develop foundational capabilities for sustained success.

END

Notes to Editors:
1. Aetna UK will partner with PricewaterhouseCoopers and the Royal College of General Practitioners to provide support for PCTs and PBCs to help them strengthen and build on local support arrangements for practice based commissioning.

2. Aetna is a leading healthcare company, commissioning services for approximately 37.2 million people worldwide through a broad range of health management services and health insurance products. Aetna has relationships with more than 1.3 million healthcare professionals around the globe, demonstrating the company’s commitment to providing customers and individuals with access to safe, affordable, high-quality healthcare. Building on its more than 150-year history, Aetna is recognised for its dedication to cooperating with doctors and hospitals, employers, patients, public officials and others to build a stronger, more effective healthcare system. Aetna UK was established in 2007 to offer dedicated commissioning support services to Primary Care Trusts (PCTs). As one of only six U.S.-based suppliers selected to provide advisory and commissioning services, Aetna UK is approved by the Department of Health through its sponsored Framework for procuring External Support for Commissioners (FESC). www.aetna-uk.co.uk

3. PricewaterhouseCoopers has an extensive track record going back over 30 years of providing authoritative advice and assistance to a wide range of public and private health organisations, including the Department of Health and other government departments, SHAs, commissioners and providers. PricewaterhouseCoopers also works in collaboration with other key stakeholders such as Monitor, the NHS Confederation, and quality regulators, such as the Royal Colleges and the Audit Commission, to add insight and expertise in key areas of policy and delivery. www.pwc.co.uk

4. The Royal College of General Practitioners (RCGP) is the academic organisation in the UK for general practitioners. Its aim is to encourage and maintain the highest standards of general medical practice and act as the ‘voice’ of general practitioners on education, training and standards issues. Founded in 1952, the RCGP is a relatively young organisation with an outstanding record of achievement. Milestones in its history include the establishment of vocational training in general practice, the setting up of clinical guidelines for doctors, the expansion of research into general medicine practice and the promotion of primary care. www.rcgp.org.uk

Aetna Positioned to Expand in England: Appointed by Department of Health to the ”Framework for Procuring External Support for Commissioners” (FESC)
–Aetna to offer range of services to support Primary Care Trusts–

HARTFORD, Conn | BUSINESS WIRE | 5 October 2007

Aetna (NYSE: AET) announced today that it has been appointed by the Department of Health as one of the suppliers on the Framework for Procuring External Support for Commissioners (FESC) to offer commissioning support to Primary Care Trusts (PCTs) in England. The FESC will provide PCTs with easy access to a framework of expert suppliers who can support them in undertaking their commissioning work.

The NHS provides health care coverage for all citizens in England, based on need, not ability to pay. It is the largest organization in Europe and one of the largest employers in the world, with more than 1.3 million employees. Originally created in 2002, PCTs are free-standing local organizations within the NHS responsible for ensuring that community health needs are met. In consultation with community stakeholders, PCTs develop health care plans that best meet the needs of their individual patient populations and commission services with providers.

Services that Aetna will offer to local PCT managers include a wide range of support, ranging from specific tasks such as designing medical management programs, also known as demand management, to comprehensive contracting and procurement of services.

“We are very pleased to have been selected as a supplier on the framework by the Department of Health in England,” said Ronald A. Williams, Aetna chairman and CEO. “We believe we have a range of skills that complement existing experience within Primary Care Trusts, and are excited to be given the opportunity to help to strengthen health care delivery in communities across England.”

Aetna’s proven experience in managing health care quality and cost to a budget through effective contracting and procurement techniques, information analysis and its partnership approach to program design were key components of the company’s successful appointment as a supplier for the FESC.

According to Martha Temple, vice president of Aetna with primary responsibility for the company’s international businesses, “Our goal is to form partnerships to create integrated solutions that address the differing health challenges and health needs of PCTs across England. We will do this in a way that truly addresses the top concerns of both PCTs and patients.”

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 34.9 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, medical management capabilities, and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans in both the U.S. and internationally. Aetna’s international businesses also include Aetna Global Benefits(R), Aetna’s expatriate benefits division that focuses on providing comprehensive benefit solutions to employees working, travelling and living in over 100 countries. http://www.aetna.com

CONTACT: Media Contact:
Aetna
Katherine Lee Balsamo, 860-273-2707
BalsamoK@aetna.com

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PBC savings frozen in bid to plug PCT overspend

Posted on November 11, 2009. Filed under: News stories | Tags: , |

Pulse | By Nigel Praities | NHS South Birmingham | 11 November 2009

NHS managers have enraged GPs by shifting thousands of pounds of efficiency savings from primary care to plug a financial overspend by hospitals.

In a move GPs claim contravenes national guidance, NHS South Birmingham has frozen reinvestment of savings from practice-based commissioning, citing ‘significant pressures’ on its budget.

The trust has further angered GPs by announcing a partnership agreement with a consultancy firm that will cost the trust millions. The PCT will pay US company Aetna £3.5m over two years to improve PBC performance and help ‘introduce best practices’ from the private sector to the NHS.

A letter sent to all practices involved in PBC warns the allocation of freed-up resources was being ‘delayed’ indefinitely.

‘The organisation is experiencing some significant pressures primarily due to swine flu, and until we are clearer of the full extent, we will need to temporarily stop the release of freed-up-resources investment,’ says the letter.

‘Once the picture is clearer, we will review this,’ it adds.

A PCT financial report reveals it is also facing ‘significant risks’ from increasing outpatient appointments and a ‘failure to cut activity levels in A&E and emergency admissions’.

Dr Robert Morley, executive secretary of Birmingham LMC and a GP in the city, said: ‘They spend a fortune on sexy initiatives with private-sector partners, but won’t invest in general practice – the one thing that will solve their problems.

‘It is a clear contravention of DH guidelines to use freed-up resources to prop up PCT deficits, but the PCT have done exactly that,’ he added.

The trust said freed-up resources would be available from the new financial year.


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