Tony Slonim's guest appearances

Tony Slonim

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8/22 Dr. Tony Slonim Updates Us on Covid 19, and the Delta Variant in Washoe County

There aren’t many people who have the breadth of perspective and the depth of accomplishment that this week’s guest brings to the table. Dr. Tony Slonim doesn’t just wear multiple hats. He has lived in multiple healthcare worlds - having earned a nursing degree, a medical degree, a subspecialty board certification, a doctorate in public health; and having served in the public health service as well as in senior executive roles. It is this unique multi-system orientation that enables him to draw distinctions between medical care, public health, community health and population health - distinctions that many of us may not fully appreciate..  In this interview, Dr. Slonim points out that our hospital-based medical healthcare system is not interchangeable with a public health care system. The fallacy that they are interchangeable - and that a public health service is not needed - is a mis-guided national error which has contributed to an American health system which delivers subpar outcomes when compared to other economically developed nations. By way of formal introduction, Dr. Anthony Slonim is president and chief executive officer of Renown Health in Reno, NV. Modern Healthcare has named Dr. Slonim one of the “50 Most Influential Clinical Executives” in 2019. Before joining Renown Health, he served in executive leadership roles at Barnabas Health in NJ, Carillion Clinic in VA and Children’s National Medical Center in DC.  Dr. Slonim holds a diploma in professional nursing. He is a board-certified pediatric intensivist, who also earned a masters and doctorate in public health from George Washington University; and then served four years in the United States Public Health Service in Rockville, MD with the rank of Lieutenant Commander. In this episode, we’ll cover:The difference between the ‘medical mindset’ and the ‘public health mindset’.The reframing of our public health system as an “insurance policy” that our country has not invested in over the past few decades.Some thoughts on how the defunding of our public health system has contributed to the disparities and inequities in healthcare.The “precedent of unkindness” in our society - exacerbated by the stressors of the pandemic and perhaps enabled through social media - that is adding to our psychologic and physiologic strain, and harming the public health.Dr. Slonim is a kind and humanistic leader, but he is also a demanding leader. He is demanding that we reinvest in a diverse healthcare system that works to keep our communities and the American public healthy. What this interview reveals is that the vast majority of us - who have not been trained in public health - don’t understand its significance and its critical role. We don’t understand the differences between public health, population health and medical care. We don’t understand the unique approaches and tools of the public health system. We are not aware that our public health system has been defunded over the past few decades. Nor do we fully appreciate the implications of that defunding, especially in inner cities and rural counties.  Many of the healthcare problems we’re experiencing today - including some of the devastating fallout of the COVID-19 pandemic - are due to this lack of a robust public health system. These problems include: unsafe drinking water (think Flint Michigan); unsafe air; climate change; the racial disparities in healthcare in which life expectancy between neighboring zip codes can vary by as much as 15 - 20 years; the worsening opioid epidemic; and the epidemic of mental health and suicide in our country. All of these have one thing in common. They could be greatly mitigated by the presence of a strong local public health system in our communities, our towns, our cities, our counties and our states.The pandemic has taught us many things, not least among them is that we need to rebuild our public health system. One wonders if our political and healthcare leaders have the discernment, conviction and courage to translate this obvious societal need into action by investing not only in the medical system, but also in a public health system. The federal government that the framers created is intentionally organized around checks and balances, informed by multiple perspectives. Our healthcare system needs that same sort of multi-system, multi-perspective reorganization.Until next time, be safe and be well.Zeev Neuwirth, MD

There aren’t many people who have the breadth of perspective and the depth of accomplishment that this week’s guest brings to the table. Dr. Tony Slonim doesn’t just wear multiple hats. He has lived in multiple healthcare worlds - having earned a nursing degree, a medical degree, a subspecialty board certification, a doctorate in public health; and having served in the public health service as well as in senior executive roles. It is this unique multi-system orientation that enables him to draw distinctions between medical care, public health, community health and population health - distinctions that many of us may not fully appreciate..  In this interview, Dr. Slonim points out that our hospital-based medical healthcare system is not interchangeable with a public health care system. The fallacy that they are interchangeable - and that a public health service is not needed - is a mis-guided national error which has contributed to an American health system which delivers subpar outcomes when compared to other economically developed nations. By way of formal introduction, Dr. Anthony Slonim is president and chief executive officer of Renown Health in Reno, NV. Modern Healthcare has named Dr. Slonim one of the “50 Most Influential Clinical Executives” in 2019. Before joining Renown Health, he served in executive leadership roles at Barnabas Health in NJ, Carillion Clinic in VA and Children’s National Medical Center in DC.  Dr. Slonim holds a diploma in professional nursing. He is a board-certified pediatric intensivist, who also earned a masters and doctorate in public health from George Washington University; and then served four years in the United States Public Health Service in Rockville, MD with the rank of Lieutenant Commander. In this episode, we’ll cover:<ul><li>The difference between the ‘medical mindset’ and the ‘public health mindset’.</li><li>The reframing of our public health system as an “insurance policy” that our country has not invested in over the past few decades.</li><li>Some thoughts on how the defunding of our public health system has contributed to the disparities and inequities in healthcare.</li><li>The “precedent of unkindness” in our society - exacerbated by the stressors of the pandemic and perhaps enabled through social media - that is adding to our psychologic and physiologic strain, and harming the public health.</li></ul>Dr. Slonim is a kind and humanistic leader, but he is also a demanding leader. He is demanding that we reinvest in a diverse healthcare system that works to keep our communities and the American public healthy. What this interview reveals is that the vast majority of us - who have not been trained in public health - don’t understand its significance and its critical role. We don’t understand the differences between public health, population health and medical care. We don’t understand the unique approaches and tools of the public health system. We are not aware that our public health system has been defunded over the past few decades. Nor do we fully appreciate the implications of that defunding, especially in inner cities and rural counties.  Many of the healthcare problems we’re experiencing today - including some of the devastating fallout of the COVID-19 pandemic - are due to this lack of a robust public health system. These problems include: unsafe drinking water (think Flint Michigan); unsafe air; climate change; the racial disparities in healthcare in which life expectancy between neighboring zip codes can vary by as much as 15 - 20 years; the worsening opioid epidemic; and the epidemic of mental health and suicide in our country. All of these have one thing in common. They could be greatly mitigated by the presence of a strong local public health system in our communities, our towns, our cities, our counties and our states.The pandemic has taught us many things, not least among them is that we need to rebuild our public health system. One wonders if our political and healthcare leaders have the discernment, conviction and courage to translate this obvious societal need into action by investing not only in the medical system, but also in a public health system. The federal government that the framers created is intentionally organized around checks and balances, informed by multiple perspectives. Our healthcare system needs that same sort of multi-system, multi-perspective reorganization.Until next time, be safe and be well. Zeev Neuwirth, MD

Episode #112: What healthcare leaders need to understand about Public Health, with Dr. Tony Slonim, CEO of Renown Healthcare

On this episode of PopHealth Week our guest, making an encore appearance, is Tony Slonim, MD, DrPH the president and chief executive officer of Renown Health, a vertically integrated non-profit, regional referral health system serving northern Nevada.Dr. Slonim is a unique health system leader with training as a clinician (both pediatric and adult critical care medicine), and doctoral degree in public health. In addition, prior to medical school Dr. Slonim’s clinical on-boarding included tenure serving as a staff nurse. Not your common background of a typical U.S. health system executive.In this episode we put that unique lens on COVID-19 from four points of view: (1) patient (cancer survivor), (2) clinician, (3) administrator and (4) public health practitioner.For more information on Renown Health’s operating footprint, see.For more information on Dr. Slonim and Renown’s leadership team, see.

On this episode of PopHealth Week our guest, making an encore appearance, is Tony Slonim, MD, DrPH the president and chief executive officer of Renown Health, a vertically integrated non-profit, regional referral health system serving northern Nevada. Dr. Slonim is a unique health system leader with training as a clinician (both pediatric and adult critical care medicine), and doctoral degree in public health. In addition, prior to medical school Dr. Slonim’s clinical on-boarding included tenure serving as a staff nurse. Not your common background of a typical U.S. health system executive. In this episode we put that unique lens on COVID-19 from four points of view: (1) patient (cancer survivor), (2) clinician, (3) administrator and (4) public health practitioner. For more information on Renown Health’s operating footprint, see. For more information on Dr. Slonim and Renown’s leadership team, see.

A COVID-19 Update: Tony Slonim MD DrPH FACHE President & CEO @RenownHealth

On this episode of PopHealth Week our guest, making an encore appearance, is Tony Slonim, MD, DrPH the president and chief executive officer of Renown Health, a vertically integrated, non-profit regional referral health system serving the northern Nevada service area.Dr. Slonim is a unique health system leader with training as a clinician (both pediatric and adult critical care medicine), in addition to his doctoral level training in public health. And prior to medical school Dr. Slonim’s clinical on-boarding included tenure serving as a staff nurse. Not your common background of a typical U.S. health system executive.In this episode we put that unique lens on COVID-19 from four points of view: (1) patient (cancer survivor), (2) clinician, (3) administrator and (4) public health practitioner.For more information on Renown Health’s operating footprint, see.For more information on Dr. Slonim and Renown’s leadership team, see.Dr. Slonim lost his father to COVID-19 earlier this year.==##==

On this episode of PopHealth Week our guest, making an encore appearance, is Tony Slonim, MD, DrPH the president and chief executive officer of Renown Health, a vertically integrated, non-profit regional referral health system serving the northern Nevada service area. Dr. Slonim is a unique health system leader with training as a clinician (both pediatric and adult critical care medicine), in addition to his doctoral level training in public health. And prior to medical school Dr. Slonim’s clinical on-boarding included tenure serving as a staff nurse. Not your common background of a typical U.S. health system executive. In this episode we put that unique lens on COVID-19 from four points of view: (1) patient (cancer survivor), (2) clinician, (3) administrator and (4) public health practitioner. For more information on Renown Health’s operating footprint, see. For more information on Dr. Slonim and Renown’s leadership team, see. Dr. Slonim lost his father to COVID-19 earlier this year. ==##==

Today on Across the Aisle I'm joined by Tony Slonim, President and CEO of Renown Health. Dr. Slonim, a former Lt. Commander in the U.S. Public Health Service, shares his perspective on where we stand in combating the pandemic, healthcare, and how the “Healthy NV Project” is helping our community.

Today on Across the Aisle I'm joined by <a href="https://www.renown.org/about-us/renown-health-leadership/" rel="nofollow" target="_blank">Tony Slonim, President and CEO of Renown Health</a>. Dr. Slonim, a former Lt. Commander in the U.S. Public Health Service, shares his perspective on where we stand in combating the pandemic, healthcare, and how the<a href="https://healthynv.org/" rel="nofollow" target="_blank"> “Healthy NV Project”</a> is helping our community.

The Nevada Recovery - Dr. Tony Slonim, President of Renown Health: Episode 4

Dear Friends &amp; Colleagues,On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introduction episode here.  In this series, I’ll be interviewing future-facing, courageous healthcare leaders and entrepreneurs - asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you’re delivering healthcare?   (2) How will COVID-19 reframe American healthcare for years to come? Our guest this week is Dr. Anthony Slonim, President and Chief Executive Officer of Renown Health in Reno, NV.  Over the last four years, he and his colleagues have created one of the most innovative and progressive health services organizations in the country. Dr. Slonim is a nationally recognized thought leader. Modern Healthcare has named him one of the “50 Most Influential Clinical Executives” of 2019. He has also been named a “Physician Leader to Know” every year, since 2014, on the Becker’s Hospital Review. A board-certified pediatric intensive care doctor by training, Dr. Slonim has authored more than 15 textbooks and published more than 60 academic journal articles. Before joining Renown Health, Dr. Slonim served in executive leadership roles at Barnabas Health in NJ, Carilion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim currently chairs the American Hospital Association’s Systems Council, representing more than 300 integrated health systems nationwide. In this interview, we’ll cover a number of topics including:How the public health mindset/model is augmenting and perhaps superseding the medical mindset/model in the COVID-19 eraHow the current pandemic is pushing many more Americans into an existence of extreme scarcity, and the economic effect on the social determinants of health and health outcomesHow Renown Health’s unique approach and operating structure - which is focused on prevention and health as well as healthcare - have prepared and positioned it to address the current situation.The escalation of behavioral and mental health conditions - a lesser talked about consequence of the pandemic, which can easily overwhelm our healthcare system, unless we find new ways to assist people.How we must use this opportunity to methodically, systematically and cautiously reframe our approach - to be prepared for not only the shock waves of this current crisis; but to be prepared for future such events by focusing on health and establishing a prepared public healthcare system.The importance of leadership at this point in time, especially at a time of widespread uncertainty and anxiety, which can cause individuals and organizations to recede into a vegetatitve mode of self-preservation.Dr. Slonim is an exceptional CEO.  In addition to being a seasoned HC executive, he is a seasoned physician and an expert in public health. In a previous interview we conducted I mentioned that we needed more CEO’s with these sorts of credentials. That was true then, but even more so now, in this COVID-19 era.  Our interview ended up going into a discourse on the type of intentional leadership that will be required in this time crisis and its aftermath. He has a perspective that I hope others leaders can be inspired by and benefit from.  These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future.Until next time, be safe and be well,Zeev Neuwirth MD

Dear Friends &amp; Colleagues,On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introduction episode <a href="https://shoutengine.com/CreatingaNewHealthcare/episode-82-introducing-a-limited-podcast-series-91911" rel="nofollow" target="_blank">here</a>.  In this series, I’ll be interviewing future-facing, courageous healthcare leaders and entrepreneurs - asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you’re delivering healthcare?   (2) How will COVID-19 reframe American healthcare for years to come? Our guest this week is <a href="https://www.linkedin.com/in/tony-slonim/" rel="nofollow" target="_blank">Dr. Anthony Slonim</a>, President and Chief Executive Officer of Renown Health in Reno, NV.  Over the last four years, he and his colleagues have created one of the most innovative and progressive health services organizations in the country. Dr. Slonim is a nationally recognized thought leader. Modern Healthcare has named him one of the “50 Most Influential Clinical Executives” of 2019. He has also been named a “Physician Leader to Know” every year, since 2014, on the Becker’s Hospital Review. A board-certified pediatric intensive care doctor by training, Dr. Slonim has authored more than 15 textbooks and published more than 60 academic journal articles. Before joining Renown Health, Dr. Slonim served in executive leadership roles at Barnabas Health in NJ, Carilion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim currently chairs the American Hospital Association’s Systems Council, representing more than 300 integrated health systems nationwide. In this interview, we’ll cover a number of topics including:<ul><li>How the public health mindset/model is augmenting and perhaps superseding the medical mindset/model in the COVID-19 era</li><li>How the current pandemic is pushing many more Americans into an existence of extreme scarcity, and the economic effect on the social determinants of health and health outcomes</li><li>How Renown Health’s unique approach and operating structure - which is focused on prevention and health as well as healthcare - have prepared and positioned it to address the current situation.</li><li>The escalation of behavioral and mental health conditions - a lesser talked about consequence of the pandemic, which can easily overwhelm our healthcare system, unless we find new ways to assist people.</li><li>How we must use this opportunity to methodically, systematically and cautiously reframe our approach - to be prepared for not only the shock waves of this current crisis; but to be prepared for future such events by focusing on health and establishing a prepared public healthcare system.</li><li>The importance of leadership at this point in time, especially at a time of widespread uncertainty and anxiety, which can cause individuals and organizations to recede into a vegetatitve mode of self-preservation.</li></ul>Dr. Slonim is an exceptional CEO.  In addition to being a seasoned HC executive, he is a seasoned physician and an expert in public health. In a previous interview we conducted I mentioned that we needed more CEO’s with these sorts of credentials. That was true then, but even more so now, in this COVID-19 era.  Our interview ended up going into a discourse on the type of intentional leadership that will be required in this time crisis and its aftermath. He has a perspective that I hope others leaders can be inspired by and benefit from.  These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future.Until next time, be safe and be well, Zeev Neuwirth MD

Episode #90: ‘How COVID-19 is Reframing Healthcare in America’ with Dr. Tony Slonim, CEO of Renown Health

Colleagues &amp; Friends,You may not have heard of Renown Health - a moderate-sized healthcare system in northern Nevada - but once you hear how they are reframing healthcare - literally redefining and reorganizing healthcare delivery, I suspect that you’ll not forget them.  Our guest this week is Dr. Anthony Slonim, President and Chief Executive Officer of Renown Health in Reno, NV.  Over the last four years, he and his colleagues have created one of the most innovative and progressive health services organizations in the country. Dr. Slonim is a nationally recognized thought leader. Modern Healthcare has named him one of the “50 Most Influential Clinical Executives” of 2019. He has also been named a “Physician Leader to Know” every year, since 2014, on the Becker’s Hospital Review. A board-certified pediatric intensive care doctor by training, Dr. Slonim has authored more than 15 textbooks and published more than 60 academic journal articles. Before joining Renown Health, Dr. Slonim served in executive leadership roles at Barnabas Health in NJ, Carilion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim currently chairs the American Hospital Association’s Systems Council, representing more than 300 integrated health systems nationwide. In this episode you’ll hear about:How Dr. Slonim caught the healthcare industry’s attention by launching the Healthy Nevada Project®, the first population health initiative that combines genetic, environmental, social and clinical data to address individual and community health needs.The reorganization of the Renown Health system into two major divisions - a ‘health’ division addressing preventive, population-based, public health needs; and a ‘healthcare’ division comprised of acute care facilities and chronic disease management providers and services. Why Dr. Slonim believes that the doctor’s prescription pad is a metaphor for the constraints of our system and what a better “prescription” for care looks like.. How Dr. Slonim’s background in public health, combined with his own long-term experience as a patient, shaped his perspective and his approach to healthcare delivery.  There are a number of things that stand out about this interview. First, Dr. Slonim brings a great depth of clinical AND public health expertise to the perspective of a healthcare CEO, which is a rarity. Second, his thinking and approach are scientifically based, consumer-oriented, brilliantly logical, and elegantly simple. Third, he is laser focused on the needs of his patients, consumers and community. Dr. Slonim and his leadership team recognize that there are two fundamental, vastly different, value propositions that are required to care for communities. So they set about to restructure their system and redeploy the appropriate resources to deliver on those two value propositions. Their goal is to improve health through proactive community-based prevention, while creating the best healthcare system for those with acute and chronic disease. Once I heard Renown’s strategy and approach, I was left wondering why other hospital systems in the country aren’t immediately following suit.From my perspective, Dr. Slonim and his colleagues are brilliantly executing the steps of the Reframe Roadmap - reorienting their approach; redefining the problems from the primary perspective of patients and community; rebranding their value proposition to meet those needs; redesigning their healthcare delivery for results that matter to people; reorganizing their healthcare system to optimally deliver on those results; and importantly, redirecting their strategies, tactics and resources to make it all happen. What resonates the most, however, from this interview is the profound sense of empathy Dr. Slonim has for the people he serves. He shares that the biggest lesson he learned from his own cancer diagnosis and treatment was about the inequities and disparities of healthcare in our country. The lesson he learned wasn’t about himself, but about others. That speaks volumes about how his mind and heart work.  His goal and the goal of Renown Health is clearly to humanize healthcare. To make it less complex and less reactive. To make it more convenient, customized and accessible. To make one of its prime purposes the prevention of illness and trauma. To make it what people want and need in order to stay healthy and return to health. Again, why aren’t more healthcare leadership teams learning from and emulating this approach?Until Next Time, Be Well.Zeev Neuwirth, MD

Colleagues &amp; Friends,You may not have heard of Renown Health - a moderate-sized healthcare system in northern Nevada - but once you hear how they are reframing healthcare - literally redefining and reorganizing healthcare delivery, I suspect that you’ll not forget them.  Our guest this week is <a href="https://www.linkedin.com/in/tony-slonim/" rel="nofollow" target="_blank">Dr. Anthony Slonim</a>, President and Chief Executive Officer of Renown Health in Reno, NV.  Over the last four years, he and his colleagues have created one of the most innovative and progressive health services organizations in the country. Dr. Slonim is a nationally recognized thought leader. Modern Healthcare has named him one of the “50 Most Influential Clinical Executives” of 2019. He has also been named a “Physician Leader to Know” every year, since 2014, on the Becker’s Hospital Review. A board-certified pediatric intensive care doctor by training, Dr. Slonim has authored more than 15 textbooks and published more than 60 academic journal articles. Before joining Renown Health, Dr. Slonim served in executive leadership roles at Barnabas Health in NJ, Carilion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim currently chairs the American Hospital Association’s Systems Council, representing more than 300 integrated health systems nationwide. In this episode you’ll hear about:<ul><li>How Dr. Slonim caught the healthcare industry’s attention by launching the Healthy Nevada Project®, the first population health initiative that combines genetic, environmental, social and clinical data to address individual and community health needs.</li><li>The reorganization of the Renown Health system into two major divisions - a ‘health’ division addressing preventive, population-based, public health needs; and a ‘healthcare’ division comprised of acute care facilities and chronic disease management providers and services. </li><li>Why Dr. Slonim believes that the doctor’s prescription pad is a metaphor for the constraints of our system and what a better “prescription” for care looks like.. </li><li>How Dr. Slonim’s background in public health, combined with his own long-term experience as a patient, shaped his perspective and his approach to healthcare delivery.  </li></ul>There are a number of things that stand out about this interview. First, Dr. Slonim brings a great depth of clinical AND public health expertise to the perspective of a healthcare CEO, which is a rarity. Second, his thinking and approach are scientifically based, consumer-oriented, brilliantly logical, and elegantly simple. Third, he is laser focused on the needs of his patients, consumers and community. Dr. Slonim and his leadership team recognize that there are two fundamental, vastly different, value propositions that are required to care for communities. So they set about to restructure their system and redeploy the appropriate resources to deliver on those two value propositions. Their goal is to improve health through proactive community-based prevention, while creating the best healthcare system for those with acute and chronic disease. Once I heard Renown’s strategy and approach, I was left wondering why other hospital systems in the country aren’t immediately following suit.From my perspective, Dr. Slonim and his colleagues are brilliantly executing the steps of the Reframe Roadmap - reorienting their approach; redefining the problems from the primary perspective of patients and community; rebranding their value proposition to meet those needs; redesigning their healthcare delivery for results that matter to people; reorganizing their healthcare system to optimally deliver on those results; and importantly, redirecting their strategies, tactics and resources to make it all happen. What resonates the most, however, from this interview is the profound sense of empathy Dr. Slonim has for the people he serves. He shares that the biggest lesson he learned from his own cancer diagnosis and treatment was about the inequities and disparities of healthcare in our country. The lesson he learned wasn’t about himself, but about others. That speaks volumes about how his mind and heart work.  His goal and the goal of Renown Health is clearly to humanize healthcare. To make it less complex and less reactive. To make it more convenient, customized and accessible. To make one of its prime purposes the prevention of illness and trauma. To make it what people want and need in order to stay healthy and return to health. Again, why aren’t more healthcare leadership teams learning from and emulating this approach?Until Next Time, Be Well.Zeev Neuwirth, MD

Episode #71 - Understanding the Health AND Healthcare Needs of a Community - with Dr. Tony Slonim

Join us today as we speak with Tony Slonim from Renown Health about healthcare leadership.

Tony Slonim @ Renown Health - Healthcare Leadership

One IDN Leader's Opinion on the Fate of ObamacareAnthony Slonim, MD, DrPH, CPE, FACPE, president and CEO, Renown Health, and chair of CMR Institute's Board of Directors, shares his predictions on the fate of the ACA. He also describes how the ACA has affected Medicaid enrollment and access to healthcare services in his community of Reno, Nevada.

One IDN Leader's Opinion on the Fate of Obamacare Anthony Slonim, MD, DrPH, CPE, FACPE, president and CEO, Renown Health, and chair of CMR Institute's Board of Directors, shares his predictions on the fate of the ACA. He also describes how the ACA has affected Medicaid enrollment and access to healthcare services in his community of Reno, Nevada.