[mjamilkowski]

thallium205 does a great job of summarizing some of the common approaches insurers have used to try and get outcomes to be part of the payment of care delivery. We find that most physicians have not been asked what they consider to be critical outcomes related measurements and benchmarks. We are approaching the physicians we contract with on a basis of partnership rather than combatant, and as a result we have been able to achieve direct physician contracts with value-based metrics and payment components that they are comfortable with. We have the technology and analytics to support the timely and accurate reporting of the emerging experience to support them because quite frankly we are only successful if they are as well. To the point about chronic patients, we support the physicians with extensive care coordination capabilities and analytic support to identify gaps in care, opportunities for broadening the clinical team, and to leverage efficient solutions in telemedicine. We make sure all of the efforts are being communicated back to the primary care and/or specialists so they know what’s going on with their patient when their patient is not in their office.

There is a long way to go however because there is not a lot of trust and there are significant technology barriers. We believe our approach is a breath of fresh air.