one of them is some concern about leaving the incentives to generate more episodes of care in the hands of providers and possibly those providers that do very well on per episode payment have even greater incentives. ..

massachusetts actually is a very good place to be launching capitation like initiatives because there are a lot of providers that are well positioned from their experience under earlier managed care models and actually taking per enrollee not resco. now, many of these as i think in massachusetts also works as a fee-for-service payments with bonuses or penalties for quality and efficiency. and the key challenges nationwide are can be effective organizations be created or they do not exist, and can in release be attributed at aaa -- who gets the capitation payments or who is basically -- and with a capitation payment for in

raleigh? and a final issue which is not on -- line is i think it is important at some point to be involving the consumer or the patient in these payment methods peer down you know, this is a different approach than consumer directed health care, but i think that the two of them really need to come together because of these methods would be a lot more powerful if patients were engaged. if not only were they efficient providers rewarded on a say per-capita per enrollee basis, but also the enrollees have an incentive to use the efficient providers so you could get movement to them which is much more robust. you know, the key thing is we are not going to save a lot of money just by moving patients from one delivery system to another because the delivery systems are limited in how fast

they can grow their capacity, but if there was enough movements that the systems that lost enrollees noticed it and decided to improve their efficiency, then we could get much more rapid gains from this approach. and this brings me to private payers, where do private payers of it in with us? and i think there is a lot of potential for medicare to work with private payers because of their interests are the same. in fact, working with medicare blows away antitrust restrictions and facilitates working together, but there is a distinct problem of private payer market power especially in hospital care so in a sensitive medicare can pursue and just decides to cut its payments rates how much of this will actually be shipped in to

private payers as a result? you know, there are two basic strategy is to address provider market power. i don't think antitrust policy has been very attentive and has a lot of potential at least in the short term, but basically you can have basic incentives to choose less expensive providers which means revamping your insurance benefits structure because the benefit structures that such incentives. and the other possibility and that is the market approach and the other possibility is a regulatory approach of literally regulating the payment rates might all payers for a provider. neither of these has been getting much of any discussion in conjunction with health care reform. so if i can conclude in i think payment reform may have the

greatest potential to ben and the trend of a medical spending, and medicare is well positioned to lead in this area in conjunction with health care reform. but medicare's potential to lead needs shoring upper. there is probably a real need for reform of the governance of the medicare program which is getting more and more attention in congress with all these ideas about federal health boards were basically creating some thing that is more insulated from day to day political pressures from both congress and the administration. and also providing a reliable resources for cms or inouye governance entity to into the development and the payment

decisions to perform the technical functions is very important. i also think that limitations in private bear market power will have to be addressed. thank you. [applause] >> thank you, paul. that was excellent. now we will look at the state example where they are actually doing some very interesting things. the state of minnesota and read that we have paul geraghty who will discuss these recent initiatives that he is involved in. minnesota is well known for its low-cost care and high quality of care can really serve as a model for the nation and as we work toward those goals.

>> thank you, nancy. some of you who are close to the front of the room the other is a fly buzzing over the podium here and a couple of weeks ago i would have just swatted it. [laughter] but we live and learn. thank you very much, is my honor to be here representing the state of minnesota and representing blue cross/blue shield and minnesota. the discussion we are having as a nation is really not just about health care, but it is about health and wellness prevention and quality outcomes is really what we are collectively thinking about and looking at. so as we talk about what we're doing in minnesota, i like you to take a look at the slides were looking certainly at cost, looking at improving care and the king and the value being delivered in the system. on os -- i'm going to talk about how we position our company as a

held company in some of the things that are distinctive about that and then touch on some disruptive innovations because health care is in great need of disruptive innovation to continue to improve on what is happening in the country. no one of the things we have a minnesota in and think it is the backbone of the difference in the minnesota model is a the tide integrated nature of health care and health care delivery in minnesota particularly in the twin cities, but certainly in rochester, minnesota as well as a place called may el. as many as you have heard of mayo clinic in is getting a lot of play in the national discussion, we in minnesota are proud of the male health care system and is serving as an outstanding job. but i'm also here to tell you that we have a number of terrific health care providers in minnesota and we have significant opportunity to have

quality and tremendous amount of access as a result of that city of enzi the fare abuses stoma, health east, and mayo, all of these as well as our children's hospitals and a number of other institutions provide outstanding care for the folks in minnesota and this is really in a issue. one of the community ethics that i think has been enhanced in minnesota and one of the distinctive if you will is that we have learned a lot of lessons about where should we collaborate and where should we compete. and the system is to take some lessons from some of that example and i will touch on that as we move to this discussion. search leyna working on piven reform and need to repeat a lot of what you've heard of but i agree with the premise that has been put out here. if you pay for volume you get volume. and we have seen that largely

across the united states. in minnesota we have a medical homes and what we call baskets of care that are actually part of public policy and are being piloted in a variety of places so these are certainly measures that we think are important in the system as a false but we also think that global payment is going to be a very important and significant feature of how health care gets funded in interstate. it will be important that as the private sector in combination with our health systems move towards more globally oriented payments that we move that way with medicare moving that way as well so i agree with the comments that have been made about medicare and medicare payment reform. is going to be important to have critical mass as we move to that. a variety of other instruments have been put into place to sort of get at the cost issue because

there isn't one flagrant than suits everyone and you have to have a lot of different approaches so certainly we have done a things two-tier networks so some of the smaller employers who aren't making it more cost related choices are making them around when delivery system worse for them. we have done work around centers of excellence. minnesota happens to have cystine dozen new centers of excellence within the blue cross system so it gives us lots of choices and opportunities and air. we profile providers on their quality of and use that data and a that dated transparent in our market and that has been important. has it taken on the full flavor that i think it will in the future? now, but daschle has put information out there and it will become increasingly more information -- important as the information becomes more robust.

will also move to let recall a care comparison tool which allows the consumer is easy access to move through the various forms of treatment that they may be looking at to compare treatment patterns and also to look at cost so it is an important part of the equation when talking about how do we get the consumer in the equation, the consumer needs to understand we need to be more transparent as an industry about sharing information and about cost so people can make informed decisions. this care comparison tool is one of the vehicles forgetting that done changing the care model obviously we need to take fee-for-service type of reimbursement out of the system wherever we can and i think that will be an important part of the transition to a new health-care system from all of us. it will be also important to in sent the right kinds of behaviors and the benefits that we put out there so one of the

benefit plans that we see taking on a lot of interest are benefit plans where the consumer can have a reduction in their premium by managing their numbers and when i say their numbers being aware of your blood pressure and your cholesterol, being aware of your body mass index and we make that available through a number of employers today and those employers set benchmarks and then as you move toward improving those numbers and demonstrate that to move toward improving those numbers you actually get a premium reduction. those are incentive based benefits and those are important to this overall reform efforts we are talking about. some of the other things we have tried to do is in the minnesota is one of the early leaders in retail clinics and we now essentially wave copays if you use the retell clinics so try to put incentives in the benefit package to use in the right place for people to be accessing

care where you can get quality and where you can get a lower costs so it is also about having the benefits line up with where we like to take the system. one of the other things that has been a valuable conversation going on in minnesota is one that involves all the ceo's of the various health plans in town in the the large health systems in town. i mentioned to the four large systems before but it also includes the children's hospitals and some of the others, we have made open to anyone who wants to be in that dialogue that literally we are as a group of leaders meeting every couple of weeks talking about how do we as a private sector reform the system and do the things that are necessary to deliver the quality and out comes and access that are expected of us here should be expected by every person in our state so we have some some very aggressive parameters for

ourselves. we want to find out the trendline. we want to make that less than cpi if we can and all of the health systems have come forth and said is they are interested on global payment. they like to engage those dialogues so we are not as far shape, mid-season form if you almost that's an ace of a staff that you need. but torii hunter and jered weaver carried that team first couple months of the season. torii hunter is having an m.v.p.-type season. jered weaver is pitching the best he's pitched all year. when they needed someone to step up with all the injuries to their rotation, jered weaver took the bull by the horns and said, this is my staff, i'll lead you, and he has. >> the team the angels play tonight, another game against the texas rangers, who are just crumbling, just three wins in their last ten games after this great start. what has gone wrong in arlington? >> we didn't know if their pitching would last. when they started getting hot, you didn't know how their pitching would, but we thought their offense would. that to me is their biggest problem. they don't get on base like they

have. they're 25th in on-base percentage, 28th in strikeouts, 27th in walks in all of baseball. so what they had last year with josh hamilton, milton bradley, guys who would work counts, guys who would make pitchers go deep, now they're just up there swinging. you wouldn't see the best hitting coach in baseball would have a team that is just a bunch of free swingers without any concept or any idea of how the approach an at-bat. but right now that's what they are. they need to go back to the basics and start taking pitch, working counts, getting into hitter's counts and walking a little bit and then hitting the home run. >> you know it because you lived it. it is so hard to determine and weigh in, in this long season that is a baseball season of finding out if an issue is serious or not. then we have the yankees, five straight win, three and a half out of first behind boston, and now they take on the surprising seattle mariners. let's talk about the yankees quickly. do they have something going

now? >> they do. we knew that they were going to score runs when teixeira got past his early season struggles that he has every year. you knew they were going to score. the problem i think i have with the yankees is they have a bunch of d.h.s in that lineup, but i think phil hughes and brian bruney, they have solidified the weak point of that team, which has been middle relief to get to mariano rivera. i think phil hughes has chance if they keep him in the bullpen to be a guy that allows joba chamerlain to stay in the rotation. he has that dominating stuff when he only has to pitch one or two innings. >> in the a.l. east, boston, yankees and ray, but you can only pick two to get to the postseason, which of those two of the three? >> i still think the bullpen for the rays will rear its ugly head somewhere. they don't have a closer yet. they're using j.c. howe there now. i think that will be a concern down the stretch when their pitchers start getting tired and they can't go deeper into games. i think the rays will be the odd team out, but don't ever count them out.

that's tough to do. but i'm doing it. >> you've done it all you life. , no i'm just kidding. the talk continues on "baseball tonight" at 10:00 eastern tonight. >> top stories coming up, including a look at what's going on in wimbledon. another williams-williams final just two wins away. plus on the eve of nba free agency, we ask who is the biggest difference maker available. opinion coming up on "aircheck." opinion coming up on "aircheck." creer we only shoot beautiful things you see. action. cut. mmm...she's had work done. cut it. take it all back to one. i yell cut. i know. shhh.

excuse me. you've changed and i love it. here's another "nattyism" with natty light. today's word is "natastrophe." "natastrophe." the unfortunate loss or destruction... of one's natty light. as in... once bill took his eyes off the prize... and put them on natalie, the party turned into a complete natastrophe.

natty light. now you're talkin'.

>> early evening in london, a break from the heat. temps approaching 90 degrees for ladies quarterfinal day. up first on quarter one, the five-time champ venus williams against victoria azarenka, into the quarterfinal for the second straight year. >> venus continues to impress you with every aspect of her play. she moves well, she was powerful. there was really not much that agnieszka radwanska could do. venus really overpowered her opponent. >> venus has won 28 of her last 29 matches here and 33 straight sets. looks easy. it's not. >> i was hitting almost perfect in the second set. i think i got a little bit

impatient the first couple game, but i was able to mentally bring it back and realize that maybe i did have to hit a few more balls because everyone upped their game, especially after the first set that was one-side. do i feel invincible? i'd like to say yes, but i really do work at it. >> two-time champ serena william, her match with victoria azarenka never short on emotion. >> absolutely not. azarenka is one of the up and coming players. she beat serena earlier this year. by serena, talk about raising your game. she raised it from the start of this match. she was awesome, serving beautifully, hitting huge off both wings. azarenka tried the make a little push in the second set, but serena not only hitting big but moving beautifully. she was utterly dominant as she took out azarenka in straight sets, a routine quarterfinal. this was supposed to be a real tough test for serena. >> tough test. so it's the tenth time that both williams' sisters are in a slam semifinal.

so good thing they're playing doubles because they wouldn't be getting a whole lot of time on the court if it was just singles. they're dominant really. >> i can't remember a time, suzy, when both of them throughout the entire tournament have played this well. neither one of them has come close to dropping a set, spending just over an hour per match, mary jo. it's almost impossible to say one of them is playing better, but i can tell you what, they're playing far better than anyone else in the field. >> in the doubles, too. >> world number one dinara safina enjoying her best wimbledon showing against sabine lisicki. >> she would win the first set 7-6, and safina would fight her nerves and battle back. >> safina in her first wimbledon semifinal. and finally show -- francesca schiavone and elena dementieva. >> dementieva looked great.

she seemed to iron out the problems with her serve. i think grass helped her serve, being able to slide around. from the back court she's as good as anyone. the question for her in the semifinals is can her serve hold up against serena williams. that's the big question. both sisters have to be huge favorites, mary jo. >> oh, absolutely. if they play the way they did today or how they've been playing this tournament, very difficult for anyone to make a move against them. i think dementieva probably has the best chance. it looks like an all-williams sisters final ahead. >> ladies finals coming your way on thursday. as for wednesday, the best and deepest field for the men's quarterfinal ever. we look forward to that. our coverage begins 7:00 a.m. eastern time on espn2, we'll see you then. andy roddick facing lleyton hewitt. expect a fight.fthis. >> i like what he does on the ti field. ig ht ahe last night of the regular season. ightast asleep. ightt made aft me erstop and go. >> the power. >> mike and mike.fter t >> we are mike and mike, where k

this morning i took the side ofe chris evert, not just because she's the first woman i ever loved, but because she happenste to the right. the gruptsing in women's tennisl is a distraction. it is both a distraction i think for the opposing player and inip that regard it is gamesmanship if not cheating as martinand nog navratilova called it, and if nothing else, it is a distraction/frustration for the fan. you get hfoeadache watching theh tennis match. >> well, if you get headache, that's fine. h listen, is it a little annoying, yes, but is it going to make me stopwatching, no.. the cheating comment by martinan navratilova is ridiculous to me to call it cheating. and i wonder, they both played,t chris evert and martina played when monica seles played, right, >> seles came along at the end , of the career.on >> she grunted.s t >> she's the first one i can remember. >> you d idn't hear anything out of those two then. now all of a sudden more people peopt and it's a problem. undderstand if you don't like it, but my point is it's here right now. i don't think it's cheating. if it's gamesmanship, so what, not the sportsmanship to have -

not first sport where theiewi gamesmanship provides a headache for the viewing and listening inblic. i think they need to get rid of it. more tomorrow morning. we're "mike and mike in the morning" on espn radio and espn 2.

>> all right. time to keep you current. michael vick is leaving his construction job to work at a boys and girls club.

much mustain has overcome his aldeck imissues and is eligible to play in 2009. and eric hinske has been acquired by the yankees for pair of minor leaguers. >> ahead this half hour on espnews, deja williams at wimbledon. serena and venus continue towards that collision match in the final. as teams prepare to fill holes through free agency, the pistons have created one at the head coaching position. change of fortune in houston. how yao ming's troubling