and go to free. there's a whole section of free materials you can get, including our models. we also have a white paper that we did on this going back a couple of years. we have set up a subgroup sch is currently doing regular phone calls. they are open phone calls. anybody, anybody in this room can sit in them. if you have nothing else better to do with your life. i always picture a 4-year-old man in his mother's basement, but i don't know why. just sitting down there and calling in. you can do that. anybody and everybody can provide kpents, suggested changes, however you want to do i. we 'gone through a series of calls now where we've hood all of the stake holders, the providers, the consumers, of course, others that have come in and brought us their ideas. and we're going to soon start the process. we're updating it.

there are a couple of areas that we are clear we need to update. one is the concept of an essential community provider. that's not something that we were really looking at before. are those now included in your networks: there's also just issues in the new environment. are we applying it to all man e managed care. do you go out to ppos? do you go out to others, as well chlts we're having weekly calls. in fact, our next one is thursday, july 24:00th at 130 p.m. mark it on your calendars. be there. we've received comments from about 30 different i. groups so far. we're going to go and see where we need to update our model.

this is always going to be our number one point. we don't want it one size fits all, federal government comes 234 and this is the time and distance for each type of provider. i don't know about you, but wyoming is just a tad different than los angeles. what are the standards? what about certain populations? as has been braugts up, we need to balance. there's no sense going here and saying we need to get rid of all of these. no narrow networks. we need to balance quality. we need to balance affordability. and then we need to balance access. how do you do that? how do you do that in a model

and make sure everybody is protected is our number one concern. some of the key issues we're looking at. tiered networks and narrow networks. tooered are if you go to this group, you to pay this much. if you're this much, you're that much. special form lairs which we're looking at more and more now than we have in the past. how are those set up. we will cover you either as in-network or out-of-network. if you go outside of the state, we will pay nothing. it's not even like a high herb cautionary. we're going to have to look at that. we're going to look at directors. i think that was already addressed here. this is probably the most critical issue. you can't have a free markt when people cannot get access to

information. we have that this year. i'm not placing blame on anybody. it was a rough year. just help me get things up and running. consumers need to know if they purchase that plan, is their provider in the network or not. they have to have dleer access to the web site to make sure they know which ones were in and which was not. i had providers say i had no idea. i said i'm in. i have a contact with that company. .

are some of them narrow? some of them are not narrow. do people know the difference and do they have the options available to them. so the drekt ris, are they accurate? >> this is where you go into a procedure. your doctor is in the network. your hospitals are in the network and your anesthesiaologist is not. that's called surprise chlts you're going to be charged higher for that. states looked at this, federal government has looked at this.

>> if you are interested in this, please, join the calls. we hope to be done by november of this year with a brand new model that states k use to update their procedures. if you want to be part of that or just know what's going on, jump on the calls. we'd love to have you. thanks. >> terrific. thank you so much, brian. brian has agreed in the course of the q&a session to channel his inner joeling. so you now have a chance to join the conversation.

you can tweet a question using the hash tag network adequacy. you've got all sorts of channels. and the first thing i want to do is sort of a factual clarification. we hear a lot of talk about innetwork and out of network. houmt people don't know the dimpbs between in-network and out-network for purposes of this. discussion. is there a typical pricing pattern? in other words, what's the penalty? maybe not out-of-state being zero. but in a typical plan, if you are in a narrow network, and have to go out for some reason or think you do, is there a substantial differential or is it fairly nominal?

how important is this? >> dan, you have any sense of that? >> sure. again, i think it's critical from the point of view providing value to consumers that we allow these high-value networks to be a choice. as many of you heard from a number of speakers today, many of you are buying based on premiums. to get that premium down to an affordable level, it's not the om option. uf broad networks. available to the 90% of the population. its's a choice there. there are certain requirements to go outside that network. plans don't say you can't do that. but they'll work with the individual on their specific needs. so if there's a particular type

of specialist that simply is not in the network and the plan has an obligation to work with that customer to find someone out of network that can provide them medically necessary service. if i can add something, part of it depends on the type of plan you have. i would say the differences are sub tan shl. i think they have to be for the narrow approach to work. it's not just that you'll pay a high higher co-insurance rates, but that you won't be benefitting from the assurance negotiating ability to negotiate a network price.

and, paul, was it typical that if that happens, whatever the out of pocket expense incured is, doesn't count toward the out-of-pocket limits. the co-insurance counts, but not what we call the balanced billing. >> ork. okay. yes, sir. do you want to identify yourself? >> sure. my name is daniel davis. i'm with the administration for community living in hhs. and one of the considerations that we're looking at quite a bit right now is the access to providers for people with disabilities. in narrow networks. specifically, there are considerations where there's been a number of studies on subspecialties where there's 20 or 40% of providers, according

to some secret shopper tests, that in certain subspecialties, don't serve patients with mobility disabilities. and to what extent are naic and the private insurance industry and were making sure that there isn't inadd ver tant health status discrimination. >> it's an issue and something we need to look at. something that state regulators when we're reviewing the various plans.

>> they're a qualified plan by the federal government and they're certified. so they have to meet the standards set in statute and in regulation to be able to compete. and we take that very seriously. and if you don't meet those requirements and you're not certified to be in the market. >> yeah, having the gentleman from the administration asking that question reminds me of a question that was submitted in advance that is related. and it makes reference to the fact that the administration had communicated with plans not so long ago that they were going to focus on areas that have -- and the questioner actually kwoess

historically raised network adequacy concerns among others mental health department providers. i wonder if we have any other elaboration. >> i will just add that clearly, that's a consideration. we focus so much on whether the physicians and the hospitals in those networks and that becomes the bulk. and as brian pointed out, then you have the anesthesiaologist behind. my point was there's outpatient access that needs to be considered. there's all-over-the-care continuum. and that entire network has to be considered.

i don't have any specific examples for you, but i absolutely agree with your point. >> i have two questions for the gentleman. one, in the satisfaction surveys that i think you presented, did they break out people with chronic illnesses or people who have had a serious illness in the last year versus healthy people? most people are healthy most of the time and if they don't use their network, they'll be satisfied with it. my second question has to do with choice. it sounds like each insurance company will present a variety of plans, i guess maybe they're required to present bronze, silver, gold, platinum.

when they have five insurance companies offering 50 plans. that's hard to deal with, especially doing it every year. most people didn't change their primary plan. they just kept the same plan year after year, even though it wasn't the best plan for them. so two questions. >> thank you for those. first, on the pole, the commonwealth survey that i mention on my slides were very comprehensive. i don't have the actual sample dated in front of me, to answer your specific question. if you go to their web site, they provide a very thorough explanation of where their sample is drawn from. so you can find whether or not it covered the specific populations that you mentioned. >> or when they're separated with the specific populations. they don't really know. they've never had to use it. >> right.

and that survey also included those that actually have used their plan, too. and there's data on that, as well. i encourage you to go to their web site. it is very comprehensive and very informative. in regard to your second question, if you could repeat that for me! sure. do you worry about the fact that people are going to get confused by having too many choices? and each one has a lot of information. the part d sneerns hants been all that good of a choice. >> some are very sophisticated about looking through web sites and finding out what's best for them. others need a lot of help. and that's why the aca provides for navigators, sisters, you have brokers, as well.

and others that can help individual choice plans and make what's best for their families. health flannels are doi health plans are doing a lot, too, to help individuals make the best choice. you know you're going to have a specific procedure and the out-of-pocket choice and the like. >> i think the structure of the offerings, by being grouped into tiers defined by actual ware value, probably helps consumers a lot. so the numbers of plans aren't as great.

>> i actually wanted to follow up just a little bit. one is the question of how a consumer in trying to make the choice can distinguish between a narrow network and a broader one. and presummablely, those aren't two different things. there is a blend. there is a range of narrowness, if you will. they help to understand which of the choices they're making along that spectrum. >> i can answer that. and reading the mckenzie study,

they came up with their own definitions of, you know, whether it was ultra narrow or just narrow. and it was based on what proportions were in the hopts. so the plan that has the lowest network of providers is called a narrow network program. so in a sense, consumers can put some aside. and then they won't be standardization, like actuarial values. but at least it would help the consumer simplify their zej. >> brian, any talk of something like that in revisions that the naic group is considering? >> no, not at this time. as far as in our model, it's something as far as choices and information, i think states would like to look at.

i'll just add that plans do provide a summary of coverage. so that's important information to shop around. they're currently working and building that in to resource that. >> i think with part d, it will take a while for part d for the web site to get to where it needs to be to provide all the information that consumers want.

but uf to walk before you can run. i think you find the experience has try today do too much on their web sites. ran into some real challenges. >> hi. the question with one of your last comments was i was wondering if any of the panelists could speak to what has been successful strategies for insuring consumer access to this type of information specifically with regard to quality and performance data. i think it was in everybody's sort of presentation that this was a key criteria not just for provider selection, but, also, the consumer's ability to access that information, understand it and use it to make informed choices.

specifically with regards to changes, how do we support consumer access not just to planned performance or quality metrics, so being able to rate plans by quality data, but, also, consumer access to how providers themselves are forming quality metrics. that we would make the case that if we're looking at narrow choice, are high-valued netsworks. refer to how individual provider ins the network or facilities are performing in quality metrics. ? a way that's consumer friendly and understandable to them. >> i was wondering if you might be sort of contemplating policy

changes to compel this type of access. >> can you do it correctly? >>. >> i did notice that two of our panelists organizations, together, were promoting the idea of standardizing quality measurements. i think as we get better, then it's going to be far more possible for plans to really advertise or inform about the quality of providers in their network.

>> is it a fair assessment of the state of the art that the people who measure quality aren't very happy with the state of quality measurement at this point? >> yes, yes. i think there's a consensus on the direction of the measures of quality and replacing them. then we wuld have the ability to do more. >> i think we would make it for collaboration, as i stated earlier, having so many different ways. you get completely different contradictory conclusions. you don't get any conclusion as to who's the best kwaumt.

i think this area has to be improved, needs to be universal and we need to be working with insurers and patients to come up with the right quality metrics. >> d you feel that's best done in the private sector or in the public sector. >> as far as we have to go, it's certainly going to start in multiple areas. public and private. i think our point is the ultimate goal will be single. it should be something universal that we're all accustomed to and understand. i think in the interim, we'll work with insurers, we'll work with hhs. we're interested in pursuing this to not narrow the quality of care but make it more understandable and comprehensive. >> let me just digress for 30 seconds and tell you that jim tallon who is on the alliance

board and who runs the united hospital fund at new york city once observed that because of all of these various reading systems, new york city contained one of 40 top hospitals in the united states. yes, gary? >> stuart gor dan with the national association of state mental health directors. in the mental health field, a lot of services are provided through peer support in mental health and substance abuse. in an aligned area, i know a lot of services, despite scope of practice laws in the states, can be provided by nurse practitioner who said physician's assistants. is that something, i guess it's two facets of the same issue, is that something that naic is looking at? >> it's not currently on the table. it's an issue that we're going to be looking at. we've tended in the past not to get much involved.

who provides the care and toez sh certify cases, you know the number. >> i should say that we received several questions on cards asking about the role of non-provie dance. i wonder, are there state that is have taken steps to define adequacy to include some of these non-fogs providers? anybody know? there's a crowd source question for you. if anybody knows the answer to that question, and will send it to us, we'll put it on the web site. >> thank you. my name is chairman wilen. and catherine, you've come

across conveying, caring for, the consumer and, yet, lamenting that your narrow network lacked an out patient laboratory that the narrow network included a hospital laboratory. but it didn't seem easy for the consumer related to parking issues. which i totally understand. but it would seem that they have all of their information that that little parking ticket could be validated at the lab. so it would not necessitate hiring or contracting with an outside lab. just a simple thought bubble i had. >> appreciate the thought. we would be happy to serve all

outpatients for testing into that garage or that parking lot as easy as possible whether it's getting a ticket validated. but even just getting that from the garage in, sometimes there's trouble walking from that parking lot up to the entry. most folks may not want to come to that big, hospital campus. they may want to go to the accessible quest lab that's sitting there a half a mile from their home. >> most of the parking lots that i've been in for hospitals, they have a button as you enter the parking if you need assistance. >> sure. and, again, we'd be happy to provide that. >> my background is i ran ptsd working for the man by the name

of leonard schaeffer. so, obviously, what are we really doing for kids that absolutely must have tertiary care, children's hospitals and so on. id just talked to a man the other day who had a very complex heart disease and wanted to send his child to a surgeon who hadn't done any heart surgery on kids in about ten years. luckily, got him into children's hospital. how are you addressing very complex needs.

>> it's important that consumers have the right information so they can make the best choice for their families to get the care they need. >> i have an answer to the question, you know, this sounded like a case of a need for a very speedy appeals process to provide access for very specialized care to those provider who is really are experienced in it. . you know, one of the observat n observations is often the pediatric hospitals are, by far, the highest-priced hospitals in the area. so the inclination to create a network without some of them, i can fully understand that. but, you know, if you're going do do that, comes the obligation of providing access for those that cannot be served in the general academic medical centers that are in the network.

>> i just add consumer education and involvement. >> if i could just add to that, auchb, the commissioners do get involved in these kinds of cases. they work very closely with the insurance companies, as well, to the consumers, to try to make sure if it's determined to be insu efficient, to just resolve the issue. instead of just saying you've got to cover everybody, let's deal with this situation by situation. that's why the gree vens procedure is there. just to make sure everybody can resolve the issue. and it most often does.

this one actually is also directed to you will you, brian. what's the naic bogs, if there is one, on mid network removals as we're seeing with the advantage plans. what happens when you sign up for a physician you want and they -- >> it's being notified of those changes and then, make sure that if there's an issue of continuing of care that is taken care of. this's been a change in the marketplace. where we go in and we do have a policy. we really didn't have that before. so we are going year-over-year. so we are looking at how that can be resolve d.

>> did you want to comment on that? is there a general industry practice for that kind of situation? >> well, you mentioned medicare advantage. >> over 10 years for ma plans and the administration has added some additional cost reduction on top of that through the regulatory process. so plans have to find a way to provide value to consumers. and some of that is bi, you know, taking a closer look at their networks and see if there are ways that they can, you know, taylor their networks to provide more value to consumers. we feel that is important and we're working towards that goal.

>> we should start thinking about how to move the system so that all network agreements between plans and providers can form to the date to the plan. so we're on a calendar year. so this position would be very limited to the provider that got out of practice orr something like that. >> and i'll just add, too, which i think is an important part of this debate. there have been numerous studies out there that show tremendous price variation with little or no correlation to quality. so that is something that we have to take a close look at. let eets focus on those provi r providers. giving the tremendous evaluation in this country, you can provide

good, quality service finding those providers that provide valuable, high-quality services at a lower price. that's the premise on doing networks. if we just open it up to everyone, including we're stuck back in this fee-for-volume type system which we all agree that we have to work on. this is a way of working towards a value-based system. >>. >> let the record show we've responded to tweeted questions. >> yes, go right ahead. >> sure. this question is for brian. but for anybody on the panel, brian, going back a couple questions, when you mentioned stepping in, when a kneltwork

was determine today be inadequate, what networks are determine today be inadequate. >> it fends on the state and whether it's in the law and the regulation as to what the standards are. they're going to file their plan at the beginning of the year. they will look at that. if they don't approve it, then they will ask the company to refile it. so you've got to get that approved, first: then, if after during the year there are a lot of grievances and issues, then, of course, the state, as the regulator, can step in. can ask them to make changes to fix issues. eventually, you could find them.

you could withdrawal draw their license. you talk to the company and usually resolve of it that way. if they're not actually fulfi fulfilling their access plan, then you can take action against them. >> there are two issues that i haven't heard addressed so far. how would they go with just the privilege of going to them? >> secondly, the subject of

conscience clauses, since we have a representative of the catholic hospital systems. what obligations does the health plan or provider have to ensure that that is able to get the medical treatment necessary. vrjts i may be wrong about this,

but if you're a plan, you have the responsibility of making sure services are available through one or another of the providers. >> it really dmends on the state. >> we follow ethical, religious directives. but as patients and families access these plans and are wanting the services, it's determined at the plan level. >> so how do you do that? let's say you're a hospital -- in fact, let's say you're the only hospital in a geographical area. and a provider -- and you decide that something is not consistent with your religious -- with the

provide providers or the owner's of the religious believes. >> i can't comment on all. i can tell you, in our markts, we're not the soul provider in our markets. >> and i don't want to we labor it, but we are getting a little bit off the question of adequate net works at the plan level. i want to make sure that we don't miss out on the opportunity to get to these questions. that means calling on you. >> thank you. i represent a number of provider organizations. thank you, this has been a really terrific panel discussion. i'm glad the topic of network adequacy has been brought up with respect to medicare advantage plans because i think some of the same issues regarding transparency at who is

in a network at any given time and then there's sharon brown that has introduced legislation pertaining to those mid-year terminations. but on the topic of network adequacy, you know, the question was raised of what do you do if you determine that a network is inadequate. what are the tools being used to ascertain whether or not a net adequate. you raised a really important point at the beginning of this conversation.

i would welcome the response. they're not looking at a medical subspecialty. should they be doing a little more deeper dive if that ophthalmologist didn't provide retina scans to find out do we have, you know, an adequate number of retina specialists. so i think that's a really important point. i've heard of health plans using the geoaccess reports. that does not go down to the

subspecialty level whether obtaining about the subspecia y subspecialty. >> let me just move on to the other agencies to regulate and have transparency for limited network plans. because they're just a resin. i'm familiar with anecdotes, say in ophthalmology that i know fairly well. through the academy of ophthalmologieney who just responded. we didn't know that. so we will make sure to put some retina specialists in the plan. it's just discovery that this is an issue.

i would say yes, the detail that's needed probably will have to go by subspecialty. it's going to make it complex, buff this is going to be a big part of our environment. so you might as well just do that. >> it does vary by state. not a medicare advantage, though. we don't get to regulate that. so we're excluded. >> i want to give a little bit of information and then ask a question. we've been doing a survey calling and asking about inclusion of nurse mid wives and their sfszs of the plan's provider network. and in response to our survey, 15% of them flat out do not

include a nurse-midwife in the network at all. about 40% of them do not cover them. they're at the same rate for the position and services being provided. the insurers could have the flexibility to do what we're talking about and that's understandable. but my question is, in our case, the cnns are a burst of the country. maternity is part of the central health benefits package. i think i could argue reasonably that that's a provider type that should be included. i'm wondering how you make decisions about what types of provider are and are not going

to be in your network. i think if i was to argue that the plan could be a few practice docks doing deliveries so my question is where is the line and how do you decide. when is a certain provider type necessary. >> is that an naic question type? dan, you're the default second place provider. >> again, we talked about this previously to be a qualified health plan, plan haves to be certified.

and part of that process is review. ocms is looking at this. they submitted a lot more information in terms of who is in their provider networks, the doctors and the hospitals alike. so they have all of this data now. the plans have supplied it to make a determination. if not, really, it depends largely upon the rules and the regulation that is are apply ie to meet certification. there's a measure of choice here. >> they may have a higher price level because of that. broader networks, lower out-of-pocket maximums. lower deduktblees.

it comes usually with a higher premium. so there are trade-offs here that consumers need to look ats. >> i'd offer just one follow up to that. from an irn surer standpoint, i'm not so much complaining about it as wanting to say that there's a huge opportunity for savings for the insurer to take advantage of. the practice pattern something that reduces costs. it's it's something we can do to educate them. i think it would result in savings for your members as well. >> a lot depends on state laws. we'd like to see states go to a place where nurse practitioners can practice to the top of their license. and further providers as well. so we could take advantage of those types of cost savings while preserving quality.

>> thank you. >> if i could ask you to suspend for just a moment, i wanted to take just a couple of the question that is tails nicely with a couple of questions we received in advance. and it has to do with the question of essential community providers. first of all, i want to make sure everybody knows what an essential community provider is. so i'd like one of our expert panelists to take a crack at that. but the aca requires plans to include substantial members of them, whatever they are. and they are particularly important to the lower and moderate income folks and isolated populations that catherine was talking about. how effective is the regulatory device, which i think is a threshold of saying that you need to have 20% of all the essential community providers with a change pending to raise that to 30%.

is that the appropriate way to assure that folks can provide -- that they can find the providers they need? >> i mean, as far as the neic on our work on the model we just have to put in what the requirement is. as far as the regulation we're looking at it. especially when it comes to native american and ak native and what they have to do there, they have to at least try to get a contract with them. whether you can get one or not is a question. and there are a lot of things involved. and that has to be something that kind of evolves over time. and have we have thresholds no place and now we have to look at how we can enforce that. what is necessary. and that is something we're looking at in our model is get the thresholds in there, but then from there how do we move forward and how do we regulate and make sure they are contracting with them and reaching out to them and kind of what those things mean. so it will take time. but we're working on it.

>> patrick. >> i couldn't comment on 20% or 30%. it depends on markets and access. and but i will say we are supportive of essential provider access requirements provided our history and footprint we do a lot of work and partner with qualified health clinics, as well as we are the safety net provider in many of our communities, certainly right here in washington, d.c. we do a lot of work with unity the fqhc so we are just proponents for making that coverage is there to serve the poor and vulnerable. >> i'll just add the threshold has increased for 2015. so in 2014 plans participating in the exchange had to include 20% of essential community providers in their area and now it is 30% for 2015.

and so plans are, you know, meeting that regulation. but again, it comes at a tradeoff in terms of price. to the extent you continue to expand the network access requirements and health plans, that in turn will lead to higher premiums. so we have to be cognizant of that trade off as we look to further regulate and restrict a plan's ability to provide that kind of high value to consumers. >> we have just a few minutes left. we're going to get this question and maybe a couple from cards before we finish. but i'd ask you do fill out the blue evaluation forms while we're finishing up the conversation so we can get some feedback from you about this program and others that we might do. yes, sir, thank you. >> hi, my name is doug jacobs. a medical student and intern with hhs. i understand that health insurance companies are using value as a way to select physicians.

my concern is that they would also exclude physicians who treat sicker patients because those physicians would be more costly to include in the network. so i was wondering, is this happening? and also if anything is being done to prevent it from happening. >> i have seen no evidence of that. >> i would say that when insurers are trying to look at value, which to me as two dimensions besides price. they are looking at broader measures of costs to see, you know, for an episode of care or for a period of time, which provider is less expensive. and then there is the quality dimension. i would think that insurers would want to adjust for different patient populations. but what they can effectively do is an open question. and so it is probably not ideal now. hopefully it will get better. >> and i would just note in our model and something says look for, is that non discrimination

that you are not contracting with people just because they -- or providers because they happen to care for certain types of diseases, certain groups of people. so that is something we look for and will continue to look at that as we move forward. >> thank you. >> we've got a question here i guess that would go initially anyway to dan. providers listed on plan networks may not be accepting new patients. how do plans inform current enrollees and potential enrollees about which providers are the truly available? >> good question. plans and committed to provide updates on their website. but it's a two way street. if they are no longer taking new applications and fail to provide it to the plan. and the plan makes it easy to do so through special call-in and the like. but part of the responsibility of the provider to let the plan know.

so we have to work on this collaboratively to make sure consumers have the latest information. >> catherine. >> and that is a fair comment. the providers need to be in contact with the plans for sure. i can tell you in our hill system, if someone is calling for an appointment and that physician has reached capacity, we'll ensure they get referred to someone who condition within the area but that is our practice. i don't know that that is a regulation or requirement. >> brian? if i can go back to the related question of the, maybe, not completely accurate directories or mid-year cancellations as opposed to physicians who aren't taking new patients. who bears the burden of the lag in information?

is it the patient? is it the provider? is it the plan? what happens when that surprise bill shows up? whose surprise is it? >> it depends on the circumstance. we think it is important that for example hospitals that are in the network of the plan but employ anesthesiologists or pathologists or other specialists in their hospital that are not in the plan, you know, they have a responsibility to notify the patient before they, you know, go under surgery to say, well, you know, this particular anesthesiologist is not participating in the plan that the hospital is. and so it could result in higher out of pocket costs. so we think there is some responsibility there on the hospital side and that type of situation. >> one thing i can add is that outside of this issue of

networks, that a number of states have put restrictions as to how much these out-of-network physicians can charge. just because, you know, these anesthesiologists and other hospital-based physicians, where consumers are just not in the position to be able to make those judgments. >> you know, i'd like to add just one comment to this point. and i do believe that, yes, the providers are standing in the relationship with the patient and as we've done, we are educating, we're working with them to know which providers are in their networks and not. but i do come back to as the patient or family is signing up for a network they are entitled to know whose in and whose not. and that education requirement

needs to be provided by the plans and something probably more robust than just directories. something more like examples, scenario, things to ask to the patient can be more informed. >> okay. i think that probably is a very good note on which to bring our discussion to a close. we didn't get -- i realize apologize to those who spent the time to write some very good questions on the green cards. but it is a subject that we are not letting go. obviously there is a high level of interest in it. there are a lot of complex pieces of it. and so we plan on revisiting this issue in the fall probably with a briefing, perhaps with a webinar. keep tuned and we'll try to explore this question of network adequacy as it develops. thanks to our friends at wellpoint for helping us put this program together. thanks to our emergency

panelists who filled in so greatly i think. and thanks to you for asking all the questions that we have tried to address. so if you'd join me in thanking our panel, i would very much appreciate it. [ applause ] saturday marks the 40th anniversary of richard nixon's resignation as president of the united states. this week american history tv looks back at the summer of 1974, and president nixon's last days in office. in a few moments evan davis a lawyer for the house judiciary committee's impeachment inquiry. he talks about the supreme court face u.s. versus nixon. at issue was president nixon's claim that executive privilege allowed him to refuse to hand over records of value office conversations. in about ten minutes, the three hour long supreme court oral argument in the case.