Speaker 1: Well, I think I'd like to transition now, and actually, really, this is a great segue to talking about health care delivery models or new health care delivery models. And really, when we think about it, prices and cost are sort of the sum part of everything we do to provide care, right? It's sort of how efficiently we do that, the different combination of resources, both human resources as well as devices and drugs and everything else. There are many different delivery models that are available. We can talk about primary care-based delivery models, like the patient-centered medical home. We can talk about accountable care organizations. But I'd like to start out, and Atif, maybe I'll throw this one to you, you know, it sort of assumes that the status quo hasn't been working so well for us, that we need a new delivery model. And so maybe you can talk about that and your views on sort of, you know, what the future delivery model or perhaps the ideal delivery model might look like.

Speaker 2: So it's easier to describe why we're having a change in delivery models. It's a little harder to say what's the right delivery model. And I think maybe to start out with the punchline, I don't know if there is one right delivery model. I don't think we should be thinking in that vein. But I think the reason we're having new delivery models is driven by some of the things we've already discussed. So that one driver of change on the delivery side, for example, in particular, is this value-based purchasing. So providers don't have the capacity to respond in terms of resources to devote to quality measurement. People who are, you have to have a group of people who's going to now say, okay, how do we improve coordination of care? If you're a small primary care practice, that's a very difficult endeavor. You have a very limited number of staff. By consolidation and growing, you theoretically or at least hopefully have the ability to be able to do that care coordination, the capital cost, the hardware that's necessary for implementing that EHR. So that's one key driver of innovation. But I also think we should be thinking about, I think another interesting aspect is the technology area, where we also now live in 2015, where we can now deliver care in new and innovative ways. And I think that's another important aspect of this, which is we don't, we no longer need to see Art for a follow-up visit for his surgery by going to his clinic. Say I was in upstate New York pretty far near the Canadian border, why am I going to schlep in a car for two and a half, three hours to come see you? Why can't we do that via the internet? And so I think that technology, like it's driven change in so many other industries, is driving change in health care, and I think that's another key aspect of that. And then, and that's obviously tied well into value-based purchasing and different payment models because those need to go side by side.

Speaker 1: So just to follow up on that, earlier we were talking about kind of new innovations, things like retail clinics, electronic visits, coaching, navigators. In your view, are those things that one should consider when thinking about how to deliver care?

Speaker 2: No, I think that, so a couple thoughts. The first is that I think there's a lot of really interesting models of delivering care outside our typical going to your primary care doctor to get your cold taken care of. Just you're worried you have sinusitis. Let's go circa 20 years ago, you pretty much had two choices. You could go, stay at home, you go to your doctor's office, you go to the ED. Now let's look at the options that are available to a person. We're in New York City, so you could go to a retail clinic. There are urgent care centers on every corner. You can call Teladoc 24 hours a day, seven days a week, and get a doctor on the phone within 10 minutes. You can go to the internet or your smartphone and get care. And we also have nurse practitioners will come to your home or your workplace or residence. There's a lot of choices out there, and I think that's really exciting for patients out there because they have a lot more choices available to them. That's exciting, but I also think that we do have, there are potential downsides for these new innovations. One is the quality of care sufficient? I think that's an open question, though we've done some work on that topic, and we found that generally the quality of care is comparable to what we have at doctor's offices. I don't know if that's faint praise or is that a positive. But I also think another major concern we need to be thinking about with these new delivery models is the issue that they can drive up utilization. So if you have a new delivery model that's available, it's more convenient, patients are going to be using it more. And is that going to, while that's good for the patient, and maybe that's the key thing, it could drive up utilization and increase health care spending.

Speaker 1: But they're paying out of pocket for the most part.

Speaker 2: I think that that's a key question. If patients were paying for this care out of their own pocket, I think we as a society would say, go for it. You want to do what's right for you. I think to the degree that payers, the government, and the taxpayers are paying for that, then I think there's a level of concern.

Speaker 1: Actually, if it creates more efficient care, if it allows patients to get care quicker and it's of high value, I would assume the plans would be interested in looking at that and covering it. Although that's not always the case.

Speaker 3: Well, in fact, I'm in favor of convenient care. I'm in favor of local care. But I'm also in favor of coordinated care. And one of my concerns when someone goes to a clinic on the corner in the drugstore one day, and then to an urgent care another day, and somewhere else goes online and gets information on a third occasion, there can be a loss of the coordination of care. And one of the things that I really think we want to head toward is to have delivery systems with coordinated care.