CEimpact Podcast

Pharmacy's Role with Long-Acting Injectable Medications

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Discover the benefits of implementing a long-acting injectable (LAI) service at your pharmacy practice site and the impact this service can have on patient care and outcomes. Listen to this week’s episode and learn how to elevate your pharmacy services!
 
HOST
Jen Moulton, BSPharm
President
CEimpact

GUEST
Lindsay McCoy, PharmD, BCPP
Pharmacy Manager
Village Drug Shop at Advantage

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Analyze the benefits and challenges of implementing a long-acting injectable (LAI) service in a pharmacy practice site.
2. Discuss how an LAI service can improve patient care, increase financial sustainability, and optimize patient outcomes.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-261-H01-P
Initial release date: 10/14/2024
Expiration date: 10/14/2025
Additional CPE details can be found here.

Take your pharmacy practice to the next level with our comprehensive course on the administration of long-acting injectables:
Pharmacy-Based Administration of Long-Acting Injectables: A Sharp Idea
3 hours  |  On Demand
Explore a cutting edge clinical service opportunity with this collection of courses specifically designed to equip pharmacists with the knowledge and skills necessary for the effective management and administration of long-acting injectable medications (LAIs). Course content explores diverse drug profiles, advanced administration techniques, and the strategic implementation of LAI-related services to support the needs of your patients and communities.

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Speaker 1:

Hey, ce Plan members From CE Impact, this is Game Changers. I'm Jen Moulton, president and Founder of CE Impact. If you're an avid listener, you know I've served as your host for quite some time now and the time has come to pass the reins to one of our very capable and gifted pharmacists, josh Kinsey. Dr Kinsey has been with CE Impact for more than three years now and is the mastermind behind our course content and curriculum. I'm so excited he's agreed to host the podcast because I think you are all going to learn so much from him and from all of our guests.

Speaker 1:

But before I pass the torch to Josh, I wanted to get in a shameless plug for subscribing to Pharmacist by Design if you don't already. You can get CE for this podcast plus so much more for less than $10 a month. You're already listening, so there's no reason not to claim CE credit for learning. Check out the link in the show notes or go to CEimpactcom to enroll. Okay, back to the episode. It's been a pleasure to serve as your host and now I'm honored to pass the mic to Josh. Take it away, my friend.

Speaker 2:

Hey, CE Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and I'm really excited about our conversation today. Long-acting injectable medications have been around for years, but yet so few pharmacists know much about them. Lais, as they're more commonly known, allow pharmacists to provide more effective treatment options, improve patient adherence and manage chronic conditions with less frequent dosing. Because of this, pharmacists play a critical role in patient education, administration and monitoring of these therapies, enhancing overall patient outcomes. So we want to share more about these fascinating treatment options with you today, and it's so great to have Lindsay McCoy with me today to dig into this topic and have her share her insights and experience with long-acting injectables. Welcome, Lindsay. Thanks for joining us today.

Speaker 3:

Thanks for having me, Josh.

Speaker 2:

Absolutely. Before we jump in, I would like for you to tell our learners a little bit about yourself, also about your practice site, as I know it's super unique and innovative. And then you know kind of what. Why are you passionate about long-acting injectables? Why is this something that really hits close to you?

Speaker 3:

Back to the very beginning of where it all started really is. I did my community practice residency through UGA and my primary practice site was with Village Drug Shop here in Athens and with that got to do a lot of things around town. Some wonderful clinic sites do a lot of AM care activities and at that point at the end of residency I was kind of focused more on building a practice that involves treating diabetes and hypertension and hyperlipidemia those like exciting things that we have a lot in AmCare practice that we focus on, and that was kind of my goal. I did end up taking a job as a pharmacy manager for one of the grocery chains for a few months and then the owner of Village contacted me and said hey, we're opening a pharmacy inside the local mental health center and it's a facility that they've had a relationship with for years at this point over 30 years by now and he said you know, I think it'd be a good opportunity for a lot of growth, a lot of cool things. And you know, we'll just start putting a pharmacy in and that's where it all started. So we started to, you know, dispense the injections for the clinic and then at that point we started having more and more injections come to market. We opened in April of 2015 so, as you know, more came to market and everyone got more comfortable.

Speaker 3:

The volume increased year after year and then at one point, with staffing low with the nurses, we kind of got tagged in to administer the injections and then through that I've become the primary person that does the administration through our Vivitrol program for alcohol use disorder. So I work with a team for that. So our pharmacy we're here, we're right in the clinic and we look across the lobby and we've got all the provider offices. So we have a really good setup where we have great connections with our prescribers and we can talk to them whenever we want to and let you know any concerns or things going on Just really be able to get involved with our patient care. So that's one piece of kind of everything with my pharmacy. We also work a lot with our opioid use disorder program and other substance use disorder program through the clinic and then we serve a crisis stabilization unit which is also on site here at our facility.

Speaker 2:

Wow, so unique. I you know it always amazes me I've been doing this for a very long time, pharmacy and it always amazes me that there are so many opportunities for what you can do with your PharmD. You know, like it's just, it's like it's endless and it just is fascinating to me. Sometimes, when I tell people you know what I do, create education for people, for pharmacists and technicians to you know, renew their licensure and whatnot, they're like oh, I didn't, I didn't know pharmacists could do that you know, so it's just it's always just so fascinating to hear the different options that people have.

Speaker 2:

So thanks for sharing about that. That's really really, really amazing, and it's so cool how you all are so integrated. I'm sure that the trust and respect with those providers is just I mean so strong and allows you all to just offer so many services and better outcomes for your patients. So that's great. All right, so let's go ahead and jump in to our main topic for today, which is I want to dig into long acting injectables. I want to make sure that our learners out there are very familiar with them and understand what their role could be or should be in this space. So let's just remind everyone a little bit about the background of long-acting injectables. What are they Kind of? How did they begin?

Speaker 2:

And really kind of why are they important for pharmacy practice?

Speaker 3:

Yes. So looking back I mean probably 50 years now things like Haldol and Prolixin were formulated as long acting injections and they're typically dosed every two weeks or once a month. Eyes through psych, because that's my world. But also looking at other things like your medroxyprogesterone injections, testosterone injections those are long acting injections and they really help for patients to be able to get their medication more regularly and work for adherence At least with, I know, in my patient population I've had a couple of cases of those who needed testosterone and because they were, you know, scared of needles or didn't want to have needles around because of history with needle use, they preferred one treatment over another.

Speaker 3:

You know insurance wouldn't cover other treatments like topical at that time. So you know, having having the ability to kind of work with them and help them with getting the lai going was a good thing for us to know how to do and be comfortable with it going through the years. As far as the lung at the injections we've gone from, you know you may have to give every two weeks to things that now we have an injection that's formulated to be given every six months.

Speaker 2:

Wow.

Speaker 3:

So that's an antipsychotic, but there's others, you know, all the way in between We've got things that are every two months, every three months, there's a wide range of things, and that really just helps patients be able to not have to worry about taking a pill every day, because I can't even really do that myself very well.

Speaker 2:

I was just sitting here thinking did I take my morning pills?

Speaker 3:

Exactly yes. So you know the things that we talk about, the way, the things that we coach about every single day. It's stuff for us to do. So I, I talk to people and you know if, if they're prescribers, kind of tossing out an LAI and they're thinking about it, sometimes they'll tag me in and say like hey, can you talk to this person about whichever one? And I, I tell them this is kind of just like one decision a month versus 30. And so that way you just have to come see us once a month and get that injection and you don't have to worry about it. You know that your medication is on board. Your doctor knows the medication is on board. Your family caregivers, we know that if you came and got that shot, it's there right, whereas when I fill your prescription for oral tablets, you could take them and throw them in the trash yeah, like nobody knows.

Speaker 3:

so um yeah, so it's really vital to help with adherence and just keeping people well, I mean they work.

Speaker 2:

You know, like you mentioned, the quality of life of the caregiver, understanding that they are, you know, on their medication, taken care of and are able to function throughout that month or whatnot. So, yeah, that's really great. So I want to touch back. You mentioned that there are, you know, a few that are every other month, or every three or six or whatever. Do you find it? Is it overwhelming and confusing, or is it pretty easy, like? Is it overwhelming and confusing or is it pretty easy, like, is it very explicitly stated for each of those medications as to their frequency of dosing? And do you find it that we should maybe try to streamline that in some way?

Speaker 3:

you know, so I think there are some products that have a lot of options and a lot of dosage steps and what they offer and that can sometimes be intimidating to know which one to choose based off of, you know, an oral equivalent dose or something like that. But also my thought on it is going back to we have a crisis unit here. So if I have somebody who we get started on an injection and we know that they have a history of frequent readmissions and relapse, if we can get them an injection that is going to last two months, then we know we might have at least two months of helping make sure that they're staying out of the hospital and staying well and not relapsing. So it kind of buys some extra time for the care team for, you know, making sure they can come back in for their appointment, things like that.

Speaker 2:

Yeah, okay, that makes sense. So we necessarily shouldn't be advocating for an across the board. Keep it 28 days because there are benefits. Yeah, that's exactly what I was wondering was what are the benefits of the differences? That makes perfect sense. So, yeah, so Long-acting injectables are so impactful in many ways and we're going to touch on that throughout the episode today. But what I want to go into now is what are opportunities for pharmacists? How can we be involved in this? Maybe touch on some of the doors that it's opened. Collaboration advocating for patients, expansion of services, like, let's touch on a few of those things that you know, embracing long-acting injectables at your practice side has really allowed you to elevate your practice.

Speaker 3:

Yeah, being able to actually administer the LAIs, I think has been something that our clinic, when I first came to them and said like hey, like I can give these injections, they were like, oh, I didn't know a pharmacist could do that. And so we've had several of those conversations of oh, I didn't know a pharmacist could do that. And that's been a lot of what I've been working on over the past nine and a half years on over the past nine and a half years, and we've been able to open it up. Where there's gaps in transitions of care especially, is one big one. So I have I had a patient who it was probably six or seven years ago he was released from a hospital out of town and moved up here to live with a family member, and the way that the clinic was set up, they couldn't get him in to get the injection that was due because they had to establish him in the system up here, and so there was just this time where he was due for this injection, but it was what was keeping him stable while he was in a different city, and so that was when I was able to step in and say like well, I can administer this for you, you know, it doesn't have to be through the clinic, and so that way he got the injection when it was due, he didn't miss his dose, he wasn't late, nothing like that, and he was able to, you know, stay with his family member, you know then come in for treatment at the clinic when his appointment was scheduled.

Speaker 3:

So that helped him. You know, in that way and I've had a couple of cases like that and then also expanding the option to providers that maybe not, they don't have the staff to facilitate administration of LAIs. So if you, you know, a community pharmacist can go to a practice that could have plenty of patients benefit from an lai, like a private psychiatrist or something like that, they may not be able to do it because they may not have the staff consistently or you know or we have telemed, so prevalent now so

Speaker 3:

you know, if you've got a remote like telehealth option, that's great because they can see you whenever, wherever. There's a lot of flexibility there. But if an LAI might be a good fit, you might be limiting them by not being able to offer it because physically you can't offer it. So that's another place where you know we can kind of come in and expand on that. And with adherence I mean having an adherent patient taking their medication. You know that they're taking their medication. That means that they're doing better, they're feeling better.

Speaker 3:

If they take other medications, they're more likely to be taking those medications, so helping to support their diabetes and hypertension. They're able to function independently and do more than refilling their medication more regularly. They're you know they're visiting you at the pharmacy regularly, once a month or every two months or whatever. And so you can build that rapport and build that relationship with them individually as well, so you can build the trust from them. And in this space with mental health and substance abuse, trust is a big deal and being able to have that relationship, relationship. There's things that my patients have told me when I'm giving them an injection that they should have been brought up to their prescriber but they, they brought it up to me because they see me more regularly. You know that that's my speculation of the reason, but just being able to have that point of contact regularly it's one of the things that I love so much about being a pharmacist in the community, and being able to further that to help them even more is valuable.

Speaker 2:

Yeah, I mean, building that trust and that relationship is, you know, kind of what we're known for as pharmacists, and so I think that's a key part of it. I want to, while we're on this space. It just kind of made me think of something, because you said the patients open up and you know they are more trusting of you and they do, you know, talk with you and whatnot. What has been the reaction of your patients who are on LAIs? Like what are their thoughts on it or do they? Would they describe them, as you know, game changing for their life and you know what's kind of their feedback been the ones that have been on it?

Speaker 3:

Yeah, it's overwhelmingly pretty positive. There's not a lot of the that I have to get my shot like. It's not punitive. So that's the conversation I try to make sure that we're having related to any injection or LEI in this space. It's not you have to take your medicine or you're going to end up on an injection. We don't have those conversations.

Speaker 3:

It's hey, there's this option, it's an injection once a month and this could be really helpful because it could help you feel better, more consistently, and you know you're not going to have to worry about missing a dose of medication. It's a day or two or three or more. You know we've got that medicine there. We know it's going to be there to support you. So in that way, I have several people who they get anxious when they feel like they can't get their injection, whether there's, you know, an issue with scheduling or the supply of the medication. There's an issue with scheduling or the supply of the medication. We had someone come in just yesterday who was due for the injection, and I think it was. There was a storm coming through and the clinic closed and so they couldn't get here for their actual appointment and they were at the window at the pharmacy just saying I need to get my injection. I know that I need my injection, so they are also bought into it being effective and helpful for them.

Speaker 2:

Yeah, yeah, that's great and I loved what you said earlier with.

Speaker 2:

You know, when you're trying to have that discussion with a patient and you know discussing the options of transitioning to an LAI and saying it's one decision versus 30 decisions you know each month.

Speaker 2:

So I think that's a really powerful statement as well, because you know, again, it is, I'm sure it's difficult for those patients to make that decision because sometimes we know that the meds they don't make them feel like themselves sometimes, and so it is hard to make those decisions day after day, and so it is hard to make those decisions day after day. The LEIs would just kind of make that an easier choice. So, yeah, you touched on my next subject that I want to jump into, which is some of the challenges with long-acting injectable medications and some of the issues that we might encounter as pharmacists who are administering them or who are, you know, supplying them, and one of those being inventory management. So tell me a little bit about what some of those challenges are and how you know some tips and tricks to kind of overcome those so obviously cost is one of the highest ones you owned a pharmacy.

Speaker 3:

Would you want to have an eighteen thousand dollar medication on your shelf?

Speaker 2:

it's hard, yeah, it's yeah, yeah.

Speaker 3:

So in those cases we really want to make sure that everything's lined up.

Speaker 3:

We want to make sure that we're ordering it at the right time, that we are verifying that they're scheduled to see the nurse and everything's going well, and so just on that side, we're willing to dispense it to the staff to give the injection.

Speaker 3:

We're still very specific, so we want to make sure that the medication is there for them to get, but that we don't keep it on the shelf too long, because we don't want to hold that inventory in our shelf for that long. We have set up a system where we we try to line everybody's medications up. We kind of sync everything to their injection, and so we kind of work with that and know exactly when they're going to be due and run their shot like three or four days in advance with all their other medications, and so that's how we kind of keep up with it and make sure that we're doing everything on a schedule. But reimbursement, of course, is another thing that it's tough. There are certain plans that don't reimburse too great on the brand new medications, but there are others that reimburse just fine and it's the struggle across the board for any pharmacy anywhere is the actual reimbursement of the medication?

Speaker 2:

Yeah, product yeah.

Speaker 3:

Yeah. And then you know reimbursement of the service. Yeah, if that's even an option. Some states have reimbursement for their like state Medicaid or other programs. I'm fortunate where in my clinic they reimburse us an administration fee for the services that we provide. So that's another place where partnering with the community can be helpful. Yeah, but as far as inventory goes, just trying to stay ahead of it is the biggest thing that I think is helpful because we can anticipate when people are going to need their dose.

Speaker 2:

Yeah, no, that's great, and you know, another key point here is really properly utilizing your pharmacy staff and your team members there, and that's something that we really talk about a lot is making sure that everyone is practicing at the top of their license and that everyone is empowered to do multiple things within the pharmacy, not just pigeonholed into one specific task or role or responsibility.

Speaker 2:

So can you maybe touch on how you use other team members to help with that inventory management or with that scheduling, or making sure that all the medications are synced to one day and making sure that the patient is scheduled to come in. Like how do you use your team members to ensure that that process is smooth?

Speaker 3:

Yeah, my technicians are awesome. They every single day they come in and they pull the schedules for myself and the nurses for the clinic and we're they're looking three days in advance for three business days and so they pull that and they go through each patient that's on the schedule for that day and they look to see if they've got refills on their prescription, if they need a prior authorization with their schedule. But you know there's some something wrong. They go through and they email that back to the nurse and they like, hey, there's no refills on Johnny's in Vegas. So then the nurse has a couple of days to get that refill to us. We're going to prioritization.

Speaker 3:

We work on prior authorizations for the clinic as well. So you know we can help with that. They do most of the legwork with that on that side. For my service, where I'm administering the Vivitrol for our AUD clients in our program, we have care coordinators who are MAs that do most of all of the work with that. As far as scheduling, they call the patient in advance, they call the patient after the injection appointment. So they're doing a lot of the heavy lifting on that side. As far as the clinic, when I'm administering the injection, both of those sets of people. If I didn't have them, it would be so difficult to do any of it from the dispensing side from the administration side.

Speaker 3:

So they really keep it going by just keeping that consistent task, being like doing it every day, because they're able to, like I said, get ahead of it. We know and we can anticipate what's due when.

Speaker 2:

Yeah, that's key, I can imagine, for not only the scheduling and making sure of the refills and the PAs and the reimbursement and whatnot, but also just for your inventory management too. You talked about how they're so expensive and you don't just want them sitting on the shelf, so I'm sure you don't order them until all of those boxes are checked and you know that everything has come to fruition. So yeah that's great.

Speaker 2:

Okay, so in our last few minutes for today's episode, I just want us to touch on the implementation. So we have a course that is an advanced training on the implementation of a long-acting injectable service, and so I want this to be a little teaser because I want our learners to hear what they could hear lots more about if they take that additional course. Just touch on briefly, maybe, how your practice site was able to implement that sort of a service and any sort of challenges or barriers that you saw and how you overcame them. What sort of partnerships did you have to make? Obviously, you're within a clinic, so that that was your partnership there, I'm sure. But you know, maybe just touching on a little bit of things for our learners just to whet their appetite so that they check out that additional advanced training course on LAIs.

Speaker 3:

Yeah, so, like you said, the partnership was kind of there but we weren't always in the clinic, so that partnership was in existence before you know. They asked to have a pharmacy inside their clinic. So building the partnership it may take a long time, but you know you still got to start somewhere.

Speaker 3:

So even if it's just starting with bugging one of your local offices and going to say, hey, I have a friend that works in a different private psych office and I pop in every now and again and just say like, hey, just how are you, How's it going? Remember, I really like giving injections and that would help your patients and you needed somewhere to send them.

Speaker 3:

Just send them to me, we'll take care of them and all that kind of stuff.

Speaker 3:

So just a little reminder.

Speaker 3:

So, and in the office in particular, just because of that connection, they did end up trying to send a patient over here to us to be able to do that for them.

Speaker 3:

Some insurance restrictions made it where that didn't happen, but that it at least started the conversation of things.

Speaker 3:

And then, because so many of these LAIs whether it's psych or not they have, are their brand only medications, they have drug reps and that's another way that you might be able to build that connection is either through the rep, because just letting that rep know hey, I am open and available and willing to administer these injections. So if you're calling on an office and they're hesitant because they say that they don't have the staff or the time to be able to actually administer, send them my way, let them know that I'm here and I can do that. And some of the websites for the injections have where you can list your pharmacy as an injection site, as an alternate injection site locator, and that's for I mean almost all of them that I can think of have that as as part of their website on the provider side and even the patient side of their websites. So that's another way that you could kind of work here and there to build a little bit of momentum could kind of work here and there to build a little bit of momentum.

Speaker 2:

Yeah, putting your name out there and networking, I think those are all key things to building that foundation so that the partnerships occur. I love the idea of networking with the reps because, like you said, they're also seeing all of those practice sites and they're able to hear the challenges that they're having and they can say, oh well, I have a solution for you and it's you know, over here at this pharmacy and this pharmacist. So that's great. Those are great tips. Yeah, what about workflow considerations? I know that you know, in community practice, when giving any sort of injection flu vaccine, covid, boosters, whatever's going on you know there is a process of how that's worked into workflow and, and you know, because it does require the injector to step away from workflow and move into the counseling space and whatnot. So how is that? Is that different? Are these different, I guess, from your typical flu vaccine? You know, seasonally or the process? Does it take longer, I guess, is my question.

Speaker 3:

So the answer it kind of varies based off of what it is you're administering and also your relationship and the expectations of the provider, because maybe part of what the provider is hesitant about outsourcing those injections is not being able to get appropriate documentation back or not having somebody from the office check in with the patient once a month.

Speaker 3:

So, like when I'm doing my, my injections for Vivitrol, I document in their EMR and so I'm asking questions about, you know, if they have any issues with the injection, if they're having any side effects things that I would normally ask but then also if they're having any suicidal ideation or homicidal ideation, other things, to check in on their other diagnoses, just to kind of just a soft you know touch point of someone with the medical side and then if there's any concerns I can go directly to the provider and so that that piece takes a little bit more time.

Speaker 3:

That's documentation. So your providers may be perfectly fine with just tell me that they got it and that's it. And then all you maybe document on your side is was everything okay last time? Here's the lot, here's the expiration, this is where they got it and you know, move on. So that's you know, one thing that can take some time the documentation piece, um, the actual preparation and administration can also take a little bit more time again, depending on which one, and again, I just came from administering a Vivitrol, so it's fresh right there for me, but, like that one, for instance, it has to stay outside the fridge for at least 30 to 45 minutes to room temperature, so you have to account for that.

Speaker 3:

and then, when you go to mix it, you have to account for that. And then, when you go to mix it, you have to, you know, make sure you're mixing it for about a minute, and then you have to give the injection pretty immediately after you draw it up into the syringe, and if you don't, it flogs. And then you have to, you know, do it again. That's uncomfortable for the patient.

Speaker 3:

So, there's some considerations of that and knowing the, knowing the product, knowing the medication is is important with those things. And again, that's a tip that the rep, when, when he came around, was like it clogs if you don't give it immediately. So here's some tips that you know some other people have done to make sure they don't yeah yeah, that's great so that, yeah, it can take a little bit more time, but it it's something that I think, for the most part, wouldn't be more than preparation of some immunizations that we have or have had in the past, little more complex than stepping away to give you know the annual influenza vaccine, but it does.

Speaker 2:

it is situational and does depend upon the provider relationship as well as the product.

Speaker 2:

But, as I'm hearing you say, very doable. That should not be a limiting factor of you know, oh, I don't have time or I can't step away or whatnot. It just, you know, maybe takes some scheduling and some preparation and some process thought so that it works out. Yeah, that's great. Well, that is all the time we have for this episode today. I feel like there's still so much we could dig into, which is why I want to remind everyone again of the course that we have advanced training on long-acting injectables and setting up a practice site service, and you know that information goes so much deeper and provides even more information on what I will use and pun completely intended this game-changing medication class of long-acting injectables. So, really briefly, lindsay, before we wrap up, summarize for us. You know, why are LAIs so game-changing? Why are they really going to affect pharmacy practice? Leave us with one little last nugget so that we can be excited and motivated to try to embrace LAIs more at our practice site.

Speaker 3:

Yeah. So I'll try to sum it up the best I can with access and adherence, because we know we're accessible in the community space and we can make it easier for patients to access care yeah across the board and then adherence.

Speaker 3:

So we know that those who are taking lais or are getting lais are generally more adherent than those who are on oral medications so once you have that adherence piece, you've got people who are feeling better, they're, they're feeling well, they're, you know, and going outside the scope of of psych and someone who may be taking a medication for schizophrenia. You've got people who feel confident that they're they're getting their contraception or that they're getting an HIV treatment or prep because we have long acting injections. So being a partner with them for for that and a champion for them for that treatment option can be just a good space, for I think it's a good space for a pharmacist to be in to help promote themselves even more and empower them to be a part of their healthcare.

Speaker 2:

Yeah, advocating for patient health, and I mean, as you mentioned, just even the adherence that leads to better quality of life, that leads to a better community, that leads to better outcomes. That you know it. Just it just continues to roll back.

Speaker 3:

Lower utilization of healthcare like less ER visits you know, across the board it trickles down. You've got that upfront cost. But that upfront cost has been shown in studies to basically be it offsets the reduced hospital visits and ER visits.

Speaker 2:

Exactly. Yeah, that's great. Well, thank you so much for joining us again today, Lindsay. This has been so enlightening and I hope it's been inspiring for our listeners to really kind of seek out some additional service opportunities in this space. So thanks again for spending time with us.

Speaker 3:

Absolutely. It was a great time.

Speaker 2:

Awesome. Well, if you are a CE Plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into yet another game changing topic with you all next week. Thank you,