The clinics have traditionally for 12 years worked on the care transformation and focused on that level. In february of 2012, we became an aco and we will have over 200,000 patients in and 1800 providers. We had rapid growth and thats a challenge to sustaining this. We have been successful and as an aco and surprisingly so. In the interim report, we did not save money for medicare and we did by a lot. So with that it kind of was the accumulation of a good year in the commercial and governmental setting and also with our own employers and employees. We have an initiative working direct low with them going on as part of this work. Part of the reason kind of taking off about this is here and its here to stay. One of the reasons we were successful is we have been saying that my leader who many of you probably know said that for ten years. We have been planning and i would add for those of you in the Service World like we are in iowa, you dont have to wait. You can do it now and make it wor
Questions that this one has answered. Berlin battle, operational and tactical level of war. This one is operational tactical and strategic level of war. Battle, built to deal with the known. This is to deal with the unknown. Unknowable and constantly changing. Probably trying to solve the battle with a fight out number to win. And this one wins in a complex world. Now, not only do each of those words have a very specific meaning, if you look at the battle, the implied task is to win, you had to fight. If you look at when in the complex world, the focus here is winning. The focus is on winning. In fact you may not have to fight to win. But, a qualifying mark, but as soon as i say that, people say, i love that idea. Winning without fighting. But the only way you could possibly win without fighting, is it must be absolutely clear to everybody involved that if you do fight, you will absolutely win. So it has to be clear to everybody that if there is a fight, there is no doubt who is going