as nancy just said i'm copresenting with andrew dreyfuss, my partner in crime back in massachusetts. his team leads the development and implementation of our alternative quality contract. what i'd like to do is just take a couple of minutes to try to create a context in which the aqc emerged and then andrew is going to take you through some of the main elements. in the mid-'90s blue cross blue shield of massachusetts was in trouble. it almost went out of business. it was involved in too many businesses and it was slow to emerge to react to the emergence of managed care. by 2004, however, it had righted itself. it became fiscally stable and then it became even stronger. it had significant membership growth and became the dominate payor in the marketplace by far. in 2001, the institute of medicine released its chasm report which taught us that 98,000 people die in the nation's hospitals of avoidable medical errors and they could be by abuse or omission of services and a strong statement about medical errors generally in the system. it was the first time that the magnitude of the proble

energy, national grid, hmple p., starbucks and nike, wrote to president obama and said this will dreyfuss into cost saving and energy-saving technologies and job creating innovation, creating the next wave of jobs in the new economy and provide the predictability we need to play for future business success. those are not my words. those are words of leaders in the corporate community who know something about innovation, enterprise and pre-markets. -- it's long been understood that acting on global warming is a moral necessity as well as an intellectual necessity. but now more and more of us are realizing that it makes powerful economic sense as well. madam speaker, let me as an aside thank you for your presiding at this time on this historic bill and for presiding over so much legislation in such a fair and effective fashion. this house will miss your service, but the country will enjoy your continuing service. i thank you, madam speaker. madam speaker, a future of clean energy is well worth the price. a republican governor inaugurated in the state of maryland in his inaugural address sai

joining him will be andrew dreyfuss who is executive vice president of healthcare services for blue cross blue shield of massachusetts. >> good morning. it's good to be ñ avoidable medical errors and they could be by abuse or omission of services and a strong statement about medical errors generally in the system. it was the first time that the magnitude of the problem was characterized for the nation in such actionable terms. this report came from a prestigious organization, the institute of medicine, which has lots of physician credibility all around the world. and so about five years ago, kind of having righted our insurance company, we decided that the next place to add value for our members was to improve the quality of care that they received. and we used the institute of medicine report along with studies from windberg and others as the basis for making the case for change in massachusetts. we also reasoned that we, blue cross blue shield and other insurers were the ones who purchased the care and we needed to demand change. we had for the first time data in the format and of the