We started out as an outcomes improvement company who was really trying to change healthcare one health system at a time. The move to a publicly traded company has pushed us towards products first and now it feels that the improvement conversations are not even happening. We have developed the 7 question improvement framework as well as the 3 systems approach to outcomes improvement, and those feel like they have fallen by the wayside as the acquired companies and team members haven't been taught or brought to understand the methodologies. It doesn't even feel like we talk about this any more, which is sad because it is our mission.