How Fintech Can Drive Financial Health and Food Security (Full Transcript)

484 FinHealth All About Fresh

Welcome to Breaking Banks, the number one global fintech radio show and podcast. I’m Brett King. And I’m Jason Henricks.

Every week since 2013, we explore the personalities, startups, innovators, and industry players driving disruption in financial services. From incumbents to unicorns and from cutting edge technology to the people using it to help create a more innovative, inclusive, and healthy financial future. I’m J.P. Nichols, and this is Breaking Banks.

Hey, are you headed to Austin this weekend? There happens to be a little festival there. If you are, join the Provoke team at Fintech House. DM me, Jason, for an invite.

On Sunday, Dara Tarkowsky, host of Tech on Reg, and David Reiling, host of NextGen Banker, will be talking to Mike Bechtel, the chief futurist of Deloitte, for a live session of Breaking Banks. Both Saturday and Sunday, we’ll have a highly curated group of fintech innovators, influencers, and investors for casual conversations, and of course, some of Austin’s finest food. And now this week’s episode.

Fintech is often lauded as the gateway to greater inclusivity and financial health. Too often, though, the solutions are more debt for people already struggling to get out of debt or budgeting tools that are, well, like being forced to eat your vegetables when you would rather have tacos. What if the answer actually is eating your vegetables, or in this case, using fintech as a bridge between access to healthy fruits and vegetables and physical wellness? Financial health is an important composite of an individual’s financial life, whether they’re spending, saving, borrowing, or planning in ways that enable them to be resilient and pursue opportunities.

This week, Jennifer Tescher, president and CEO of Financial Health Network, and of course, the host of Provoke FM’s Emerge Everywhere podcast, and I talk with Josh Trotwein, co-founder and CEO of About Fresh. We’re going to talk about how a non-profit accidentally ended up becoming a fintech in their efforts to not only solve food security issues, but to get healthy foods into the hands of people who need it. Jennifer, I’d like to go in the way back machine to kick this off.

When you and I first met, you were the CEO of the Center for Financial Service Innovation. Since then, you’ve become the CEO of the Financial Health Network, same group organization, but it was more than just a rebrand, a change of the logo and less of a mouthful for a name. It was a change to the vision.

Take us through the story of that, the aha moment and the evolution of what the Financial Health Network has become. Yeah, happy to. And we have been at this a long time, haven’t we? I’m having COVID brains, so I can’t remember if it was three years ago or four years ago now that we changed our name.

But in any event, we had for several years prior, had been focused on financial health as what we want for people, as opposed to just, say, having a bank account. So we had already made that shift in our own minds. But I think the more we began to focus on financial health, which is really about having a day-to-day financial system that allows you to build resilience and to thrive, we realized that we were going to need a heck of a lot more than just financial services and financial services companies at the table to move the needle, because financial health is so much bigger than just your money.

And so we started to think about what are the other sectors that play an outsized role in people’s financial health? And we came up with things like, well, a job, your employer, for instance. Talked about healthcare, such a huge factor, at least in this country, in people’s financial health. Housing, we could go on and on.

And we decided that as we were to change our name, that we were also going to expand our market beyond financial services companies. And so for the last few years, we have doubled down in particular on employers and the financial health of their workforce. And we’ve also done some work in healthcare.

And we’ve spent a lot of time thinking about the intersections, the bi-directional intersections between physical, mental, and financial health. And so I’m really excited for the conversation we’re going to have today. Yeah.

Well, and one of those intersections where this can be most acutely felt is food insecurity. And I think we all know that’s kind of a problem. I didn’t really get the full scope of it.

So in the US, arguably the most prosperous country in the world, still about 7% of the population feels insecure about their food situation. But what was staggering to me is you peel back the layers of this. If you switch to looking at only households with children, particularly children under the age of six, that percentage jumps to 13%.

And if you look at only single mother-led households, it’s a whopping 24%. The scope of that just blew me away in terms of a country with so much that we’re still doing so poorly. And when you look then on the global scale, the impact that climate and wars are having in terms of creating a global pandemic of food insecurity, it’s even worse.

And so Josh, I’d love for you to take us through the About Fresh story. Where did you find this passion and where you wanted to go attack this problem? Yeah, sure. I mean, our story at About Fresh dates back to 2013.

Prior to founding the organization, I was a program manager at a community health center managing a wide range of health and wellness programs, really thinking about all the non-clinical drivers of health, particularly like social, emotional health of kids. Nutrition and food security definitely factors into that. So one of the programs that I was running with a group of clinicians was a healthy eating program.

It was really thinking about how to develop healthy lifestyle habits conducive to just really sustainable, good health over time. And it was with a group of low-income single moms, as you referenced, who are disproportionately impacted by food insecurity. And at the same time that we were running this program, providing all this great educational programming, the only grocery store in the neighborhood closed.

And that brought into focus for me that while I was working at a world-class health system, we could provide all this education, all this great clinical care, we couldn’t do anything to change the fact that there just was no healthy food close by to the neighborhood. So that’s what prompted our initial program that we developed, Fresh Truck, some global market model, converted school buses into grocery stores, and really thinking about how to solve for the proximity of food to communities as an important underlying factor that constitutes our access to food. And then we really continued to build from there.

I mean, Fresh Truck is just this amazing grassroots, kind of like mobile market model. They’re literal school buses that are retrofitted so that you can walk inside, go shopping. It mirrors the typical grocery shopping experience.

We buy all of our food. So we’re able to kind of like tailor our inventory day to day, depending on what neighborhoods we’re in. We started to build out like block parties, more educational programming, really with the focus on celebrating food culture across all the neighborhoods that we were serving in Boston.

And, you know, just throughout the course of running those programs organically, we were hearing back from all of our shoppers that while our prices were great at our trucks, you know, money was still getting in the way of affording all the food that they would otherwise want to be able to buy, like to feed their household. And so we started to think about the role that purchasing power plays in food access, right? Like we don’t think about that a lot. People typically just think of like food deserts, but, you know, you can bring all the grocery stores you want to a neighborhood.

You know, we could build a hundred thousand fresh trucks. People don’t have the money in the bank to afford healthy food. We’re not going to get very far in terms of solving food insecurity.

And that brought us around to Fresh Connect, which started out as just like a paper food prescription and has since evolved into a really powerful technology enabled platform that allows healthcare systems and health plans at scale to cover the cost of food for people in a manner that’s aligned with their healthcare goals. So it’s been a long, long arc, but all in service of making sure that people have access to food. You know, the irony of we talk about on this show, branch deserts all the time, and is this solution, do we, you know, make people more digital? Maybe part of the answer should be we make the mobile branch that, you know, goes into some of these places where there isn’t.

And I only half kidding when I say that, because it can be nearly impossible to bridge the divide. Yeah. Although I have to say that while there are absolutely things on the payment end of things or even the fulfillment end that could be aided by technology, at the end of the day, we can’t deliver a banana through zeros and ones, you know, Josh, am I right that that during COVID you switched from the buses to like literally at home, you know, delivery of a box, kind of like a CSA? Yeah.

Yeah, we did. Yeah. It mirrored a lot.

It mirrored a CSA. We were still continuing to run our trucks. We created a different format, but we used actually components of our fresh connect technology combined with like our, the partnership that we have in place with our wholesaler to develop a direct to doorstep distribution model during COVID with the city and with a few health systems around Massachusetts.

So at what point did you realize you needed to become a FinTech, right? Like this leap from being, you know, a storefront and a box delivery company, but now you’re a FinTech company. Walk us through that. Yeah.

I mean, like we still don’t think of ourselves as a FinTech company, right? Like we’re, we’re, you know, food equity, health equity activists, they just happen to be using FinTech. Like I said, in service of our mission, but it was organic. Like we developed this like really, you know, sophisticated stack of technology that delivers on like sort of a scalable version of fresh connect, but it started out as a piece of paper, right? Like fresh connect was a literally a paper coupon that said the name of a health center on it and like 10 bucks.

And so the way that it initially worked is that dietitians and nutritionists in community health centers, when they were encountering a patient who was screening positive for food insecurity, they could just hand out these paper coupons. You can go to one of our fresh truck mobile markets and use it to buy food. And then, you know, we would just run a report at the end of the month and invoice the health center.

They would pay us and it was great. And that program became really powerful. We came to recognize sort of the role of purchasing power to a greater degree.

And we started to imagine like, well, what if we could scale this to other grocery retailers to give the people that we serve more options beyond just fresh truck to go shopping? And what if we could streamline that flow of data that I just described, right? Like what if we could streamline program enrollment? What if we could streamline that reporting? What if we could tie transaction data directly into electronic health records and other data sets to begin automating all the analytics around measuring the impact of investing in healthy food for low income households? So we really started off not with the intention of becoming a fintech company, but with all those design principles in mind. And then, you know, so around 2019, we started to, you know, drill a little bit deeper into those, you know, and wanting to like scale Fresh Connect, we started to think more deeply about like, what would need to be true if we scale Fresh Connect into grocery retailers to mirror the experience that we deliver at Fresh Truck? I mean, so much of what’s powerful about what we do is not just the technology, but the program and the experience that we built around it for the people that we serve. So we really backed into the financial technology that we use today to administer Fresh Connect from a place of wanting to ensure that we were delivering on a joyful, frictionless, and then really intuitive shopping experience, whether you’re in Walmart, whether you’re at Kroger, whether you’re at a farmer’s market, or whether you’re at Fresh Truck, we wanted that experience to be uniform for the people that we served across the board.

So that those design principles were the starting point for how we got to a place of becoming a fintech company. And then of course, like leveraging like financial technology and some, you know, adjacent technology infrastructure has allowed us to become hyper scalable and to gain much more visibility into data so that all that data can be used to affect policy change and also to help, you know, shifts in healthcare practice around how it is that healthcare thinks about embedding food into care delivery. So those were all sort of the, yeah, the grounding, the drivers behind how we got to become a fintech company.

Well, there’s something particularly powerful about starting with the what’s the real problem versus the jumping into, I want to be a fintech because one in $5, now two and $5 venture goes into it. And it really is around how do I solve some fundamentals as opposed to digitizing, right? Like Jennifer said, we can’t digitize the banana for the delivery of this. So you had to rethink, not just the digital experience, but how the whole system fits together.

I’m curious what the biggest challenge was. If you look at two of the most difficult industries to work with, healthcare and financial services, and you’re swimming in both, which is more challenging? Oh, healthcare. Yeah, healthcare.

I’d add grocery retail in there too. They’re a third stakeholder that’s as complex as the other two for sure. But I’d say, yeah, healthcare gives us our biggest challenges.

Jennifer, is that consistent with, as you’ve broadened? It is actually, you know, I think there are a lot of similarities between the financial services and the healthcare sectors. They’re both roughly 20% of GDP in this country. They both say they want to be customer centric, but generally are not organized in that way, nor are they often incentivized to be more customer centric.

And while we’re seeing in both sectors, we’re seeing folks do some good things, it is not yet fully systematized and integrated into the system, I would say. And I think the other thing that’s interesting about both industries is that they’re both heavily technology driven. I mean, frankly, you could probably say that about every industry today, but I think it’s particularly true in these two industries.

And there’s a whole part of healthcare that is just about revenue cycle management, right? About billing, about payments, about, you know, so a part of healthcare is finance and financial services. And I think that’s part of what makes it so difficult is that they don’t just have financial services data systems. They’ve got also health record data systems and a bunch of others, and they’re still figuring out how to get them to talk to each other within their own health systems, let alone with other health systems.

And so, you know, correct me, Josh, or add to the woes, but that’s what we’ve seen. No, that’s all real. I mean, all of what you just described are all the challenges that I was alluding to, Jason.

Like in healthcare, there is no shortage of technology, but quite a bit of that technology is extremely closed loop, oftentimes antiquated. So it’s, and that’s true, like the ability for, to share data, even within like the same enterprise is often straining for, you know, people within that enterprise and across departments. You know, healthcare has a habit of being extremely siloed, and that’s especially true with if you’re attempting to share that data outside of the enterprise or with third party partners like us.

And then there’s also the matter of also navigating, you know, HIPAA compliance, as well as just the realities of clinical operations, right? Like we are ultimately asking health systems to enroll their patients into the program that we have built in FreshConnect, you know, and we’re greeted by the reality that like providers are with a patient at a primary care visit for 15 minutes, and that there’s potentially going to be a handoff to maybe a front desk administrator or someone playing the role of like a care navigator. And so as much as I was describing that we need to be empathetic to that experience for the cardholders, for the shoppers that we’re serving, we also need to be empathetic to the healthcare partners that are a hugely important stakeholder. And I think our ability to penetrate, you know, some of that antiquated, fragmented kind of closed loop infrastructure has to be accompanied by, you know, a very empathetic, thoughtful approach towards like some of the operational realities from within a healthcare system.

And I think our approach to like building technology is somewhat different than I think like or like how you’d approach building other types of technology platforms. For instance, you know, it sounds really good to develop something that’s like highly interoperable, right, that can live within the existing IT infrastructure of the enterprise that you’re attempting to serve. But if there is, you know, if that infrastructure is, you know, really fragile, really prone to breaking, you know, large enterprises, especially for something new and nascent like food is medicine, don’t want to invest in interoperability up front.

So like we actually, it was very important that we built sort of a standalone platform, even though it’s not single sign on, even though like it involves a secondary login, and it’s not embedded directly into your electronic health record. That’s actually like a quite important starting point for us to just recruit those early adopters without sort of the upfront burden of having to invest in interoperability. You know, and I think there are a dozen other cases of where healthcare technology is introduced to high degree of complexity.

Hello, listeners. I’m Brett King, the host of Breaking Banks. Together, myself and Dr. Richard Petty have recently released our latest bestselling book, The Rise of Techno-Socialism.

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You can get it on Amazon, Barnes and Noble or go to riseoftechnosocialism.com to find out more. Welcome to the future. So tell us where you see this going.

So you found yourself into the payments world and you’re expanding. What’s next in terms of solving this problem? Where do you go? Yeah, let’s see. So like we are in the middle of a, hopefully, like a really macro sustained shift towards value-based care where, you know, we are collectively orienting ourselves towards taking care of people before they get sick.

Which has never been the case for the US healthcare system. We’ve only ever compensated providers based on the volume of care that they deliver. Which the rest of the world, you know, goes more towards a capitation model where you’re incentivized for keeping someone healthy, not for treating them when they’re sick.

Yeah, exactly. But we have a long way to go before we actually realize that model of healthcare. And so for us, what that means in our domain of, you know, food is medicine and food security is that the burden of proof is on us to demonstrate sort of the economic case for why it is that healthcare ought to be investing behind food as an integrated component of their care delivery.

So what we’re focused on at FreshConnect is really first developing partnerships with healthcare organizations, plans providers, community-based organizations that are committed to dynamic learning and evaluation so that we’re not only like serving people through FreshConnect, but really generating data that can support legislative advocacy and healthcare transformation so that we can affect that change. Because what we are seeing at this point right now materializing healthcare are a lot of demonstration pilots driven by the 1115 waiver and philanthropy, which are great. We’re super excited about all those things.

We’re able to serve a lot of people. But our aim, our long-term aim is to recruit healthcare as a sustained investor in food access. And so we see our work right now, not only in building great technology, not only in scaling technology and serving more people, but also in generating the data that can allow us to sustain all of this great momentum.

So we’re focused on building those partnerships and developing just a really robust, you know, model for evaluation that will drive those sustained changes. Just to put a finer point on making this into a business model is right now there are a number of health systems that really have gotten with the program on this idea of social determinants of health, right? The other things that contribute to making you sick beyond just a molecular physical condition and needing to treat those in order to help people stay healthy. So food would be one of those.

But most of the health systems that are doing that work are doing it locally in community and they’re doing it outside the business. So I have a foundation or I have a community development arm that’s focused on housing and homelessness, that’s focused on banking access, that’s focused on a range of those kinds of social determinants. But it’s very different to try to get healthcare to do something as part of the business, as part of seeing that patient and having them understand that that cost is something that A, they should bear, because again, it’s like healthy food is like medicine, but also then putting the pressure on the federal government who is actually already doing work in this arena to make things like that reimbursable by insurance companies.

So the other thing that the government is working on developing reimbursement for as part of healthcare is financial counseling and coaching, same idea. And so that’s another thing that I think is so interesting, Josh, about what you’re doing is that you’re a nonprofit. Ultimately, if you’re successful, you’re going to make it work for everyone else in the ecosystem who isn’t going to have to worry about where the next dollar is going to come from in order to provide the kind of nourishing food that folks need to stay healthy or to manage chronic conditions like diabetes.

Yeah, absolutely. And that’s our priority. We want to serve as many people as we possibly can, but that sustained shift in healthcare investment toward food and other drivers of health as well is a central point of focus for us at this stage.

I was reading up on a more global perspective on this. There was interesting research done by the European Development Bank that one of their answers to food insecurity was not thinking bigger in terms of like, we need larger, more commercial farming. It was actually a shift to local and where FinTech began to play in was how do you actually get financing to smaller farmers? Smaller farmers have a lower environmental impact, fresher food closer to the source, so your carbon footprint around it is also lower and a heavier emphasis on a lot of the fruits and vegetables, right? And there’s a FinTech in the EU called Heavy Finance that is, think of it as small business lending for small farmers, right? That is their pure specialty.

And Jennifer, to your point around this, it’s rethinking the entirety of the business model. I think it also means we have to rethink the supply chain and value chain attached to this. I don’t know.

What do you both think? That vision that you just described, Jason, I think is right on. We need to move towards more localized food systems. There’s a huge amount of opportunity to take pork out of the value chain, out of the supply chain to connect consumers more directly to growers who are up against it to capture a margin that allows them to even sustain what’s oftentimes like a generations old family business.

However, I do think it’s important to name the realities of just the underlying economics of food, which have changed radically over time, driven in large part by increase in land prices and government subsidies. It’s a really, really challenging needle to thread. I am hopeful that healthcare could actually potentially play a role in increasing consumer purchasing power.

If they play a role in increasing consumer purchasing power for food, I’m wondering to what extent that can be leveraged to, or harnessed rather, to localize food economies. If we can drive that spend towards more local food systems. So I think it’s a noble aspiration.

I think there are some barriers with respect to the underlying economics of growing and transporting food that will present as challenges towards that vision though. But back to taking out friction, that’s what FinTech is meant to do. I think if we follow Jennifer’s vision to its logical conclusion, the silos that exist between our spheres of wellness, that friction between the silos is what creates a lot of the problems, or at least prevents us from getting the solutions that it does need the holistic approach.

Yeah. It’s always great when a conversation validates your own thinking, right? So I’m one of these people who believes that everything is interconnected. And that’s not useful sometimes on a day-to-day basis, because as Josh just said, there are real challenges to achieving true integration.

One can dream though. But I think when it comes to the actual human being that we care about, right, they don’t wake up one day and say, well, today’s a food day. And tomorrow’s a healthcare day.

And the day after that is a checking account day, right? Like their lives are completely integrated. And so for me, the vision is really that regardless of the sector that we appreciate that we’re all actually serving the same person, right? Your patient is my student, is her renter, et cetera, et cetera. And that there’s really opportunities both for efficiency, but also for greater impact if we find the ways to work together to serve the same people.

And we have to start small and build up from there. But that’s why I love so much what Josh is doing, because it really is connecting in many ways, three sectors. It’s connecting agriculture and food and grocery with healthcare, with financial services.

And when we can start to replicate things like that, not just in one locality, but in multiple places around the country, people can start to see what that could really look like for their company or their organization at scale. And I think that’s what gets people excited. And I just wanted to pick up quickly, Jason, on something Jennifer said about this idea of cooperation.

I think that’s so huge when it comes to food. I mean, it’s such a low margin business that relies on economies of scale to gain efficiency, which is one of the main constraints and breakdowns within localized food economies that I’ve observed, right? Significant majority of food spend comes from large institutions like school systems, universities, hospitals. If we can leverage fintech to combine all of that buying power, and then on the supply side, aggregate growers through a more centralized, efficient distribution system, it’d be enormously powerful to shift a lot of that institutional buying to local growers.

And so that is one big challenge, but a huge opportunity that I see fintech playing in aggregating the supply side. Because one farmer can’t sell all the tomatoes that Harvard needs in order to satisfy the entirety of its food system, but 200 farmers together combined into a network could provide that reliable volume. And so I see fintech sort of playing a role in facilitating that cooperation that Jennifer just described as being really important to how we solve any big problem.

I mean, it was the idea behind peer-to-peer lending in the first place, right? And it’s funny how you can seed it by aggregation, but over time, once you’ve proven out that the system can work at scale, it takes on a mind of its own and can literally kind of industrialize itself. If we think of that peer-to-peer lending model, that was actually more institutional, but it still solves the problem for that individual that needs a microloan. I don’t know if you guys saw this quote from Mark Andreessen from over the weekend, I guess in his newsletter, he was lamenting the fact that we can now make enormous TVs that will cover your whole wall for like $100, but a four-year college degree is going to cost a million dollars.

And that while lightly regulated industries are really scaling with technology and bringing costs down, that in a whole set of other industries, think healthcare, education, et cetera, the opposite is happening. I fundamentally disagree with his assessment that regulation is the problem, like education and healthcare companies have done wonders in leveraging technology to innovate, but there’s no incentive for those industries to bring down the cost for all kinds of reasons. And at the end of the day, sometimes the only incentive is going to be the government.

That may not be regulation, that may be the government’s own buying power, as an example. But until we create the right incentive structure so that those businesses are aligned with the interests of those they’re serving, we’re not going to really, FinTech is not going to be the solution. There is something bigger that needs to happen.

It’s easy to get hung up on innovation equals technology, particularly when we talk to banks. When we say innovation, do you mean digital transformation or blockchain, cryptocurrency, less so now? But the reality is most of the innovation that’s needed is actually business model. To your point around the alignment of incentives, the realignment of incentives always requires a change to business model.

I would take it a step further than that. I think what Jennifer was alluding to is just a fundamental change in the economics of healthcare. Right? Like where we need to stop compensating healthcare providers.

And if we think about the government as a consumer in the same way that we think about consumers of TVs, if the government turns around and says, I’m going to only pay you this dollar if you keep people healthy, as opposed to rewarding you for taking care after someone gets sick. Right? That’s going to fundamentally shift how healthcare as an industry then turns around and thinks about serving people and how they deploy their own funds to cover the cost of food or to add more hospital beds. So I think that underlying change in the healthcare economy, before we even start thinking about business models, which in that economy is governed by policy, is what has to happen in order for the work that we do to sustain itself into the future.

You know, going back now to where we started the show, when I first had the twinkle in my eye about this sort of connectivity between financial services and healthcare, I was thinking a lot about this shift to value-based care, which has been more than a decade in the making and still quite a ways to go. But I was thinking about what would be the analogy in financial services, in banking, right? And the best I could come up with was that banks would need to keep their customers from overdrafting. Like, if we could create the incentive structure in which the goal was to keep someone from overdrafting as opposed to charging a fee for the overdraft, that would be the equivalent.

You know, it falls down because there’s no third-party payer model in financial services. But again, it’s about seeing the customer’s best interest as the problem you’re solving and the business you’re in, as opposed to the opposite. Well, unfortunately, that is a fundamental shift, I think, in how we view capitalism in a shift to the more constructive capitalism versus the maximization around profit.

I worry for too many that creating a system or a product like that feels too much like marketing, right? Like, it’s a marketing expense, back to Josh’s original, you know, this is less… Philanthropy only goes so far unless you can fix the system. Yep. And what you just described, Jennifer, feels like… I’ll claim it.

It’s what we talked about at Perk Street, right? We wanted to create a debit card that reward people for spending responsibly. Unfortunately, a lot of our investors said, well, that’s marketing spend. What’s the minimum amount you can reward them that acquires new customers and drives spend? Right.

Well, but, you know, what’s now happening, it doesn’t always have to happen that way, right? What’s happening now with overdraft? Banks are getting rid of it or dramatically reducing the cost of it. And I suspect with Biden’s junk fee initiative and Rohit Chopra at the CFPB, we’re going to see more of that. And so there are multiple levers to drive that kind of change.

And it’ll be very interesting to see how those levers between financial services and healthcare are similar or different. Well, thank you both for joining today. Made me hungry talking about all of this food, so I think it’s time to declare lunch.

But Josh, there’s a wonderful article on you in Past Company that we’ll put into the show notes. If people want to follow your journey, where can they learn more about what you’re up to? Yeah, you can find our website at www.aboutfresh.org. And yeah, find us at just About Fresh. That’s our handle across all the channels.

And Fresh Connect lives there with About Fresh. So yeah, thanks so much. And thanks for joining for this conversation.

Definitely go check out the Emerge podcast with Jennifer to hear more about what she’s been up to. Excellent. Thanks for having me, Jason.

Josh, so great to connect with you. You too, Jennifer. Thanks, Jason.

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