million bylaws plus so what makes that number go down in we have surplus in 2014 and have fantastic acodo their fantastic initiative and manage the care we could see a surplus we've net the surplus and less money to adjust in the rates so i'm objectives i have to be optimistic i want blue shield so stay other than that's a statement of my opinion it's not expected without further ado are there any questions. >> yes ma'am. >> i want to add the remaining recess plan for 2017 and 2018. >> yes. absolutely it goes on any other questions i want us to approve the allocation of the this is my recommendation the $4 million 4 hundred and 85078 for 2016 rate development and the chair forward of 8470445 that's it this is an action item do i have a motion from the board any questions. >> the motion is two motions; right? >> stabilization policy. >> i made two. >> for 2016. >> yes, ma'am and say that again. >> okay. i want to add that o policy $4 million 4 hundred and 85 thousand dollars to the 2016 rates based on the way we do that and also i want to have you approve the carry forward so in the minu

and an aco contract is basically a deal between the group of providers, the aco, and medicare.that benchmark, we're share in the savings. if you exceed, that we'll share in the losses. by the way, we're going to measure you on 33 measures of quality and we're going to adjust those payments based on your performance on those measures of quality. so we have results from two years of the pioneer aco program. we're now in the fourth performance year but we have two years of public results. the pioneers beat national benchmarks on 15 out of 15 quality measures for which there are comparable national benchmarks and they beat them on four out of four patient experience measures for which we have comparable national benchmarks. then they improved by a composite of 13 percentage points in the second year. for two years in a row they generated savings cumulatively of about $184 million and the savings per aco increased from 2.7 million in the fist year to 4.2 million in the second year. so pioneers are organizations that are pretty advanced they're -- they have some experience in bearing

this is a map that shows where our aco's are. they are currently aligned or signed and we have more than 400 operating now. last slide, here's what i think you will see over the next couple of years. we are increasingly focused on integrating with the rest of cms, a really important point. it is a part of cms. we couldn't function without the cms. everything we do is to improve the program that the agency runs. we are focused on evaluating the results and launching them in the portfolio. i think you will see a steady drumbeat of results and expanding models that work. one very last thought, trisha gave you three reasons why it's important. i want to add one more to that list, so here is reason number four. all of us, should we live long enough will become medicare beneficiaries. we can work on other areas of domestic policy and it would never touch your personal life but if you live to the age of 65, but god forbid, you will become a medicare beneficiary. and that's right the delivery system reform actually matters because, in th

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. >> i am aco founder of global exchange at 16th and mission a hume rights organization. i'm a co-founder of the green festival and sociology staff at san francisco state. i volunteer on a program in mission high school called green guardians with the help of puc we took out a parking lot and a whole bunch of sidewalk cement and we have a great gardening program going on. the kids are learning how to grow food and take it to the commercial kitchen we set up and learn how to cook the food. the urban agriculture program and its recent expansion last year has really benefited us in a number of ways and the san francisco urban agricultural alliance has been a big part of that. so i just want to bring sort of an emotional thank you, because when i see these kids pick a strawberry off the vine and put in their mouths and light up, it's a great educational experience. it's been my entire life has been committed to education of youth with. so i want to thank you folks and you are doing a great job on urban agriculture. and i would like to see more of it. i would like to see an ex

incentivize the choice of specialty, the movement into primary care and all these payment models, acos and others that think about team-based care which is something that our medical training programs and nursing training and other providers need to begin to think about going forward and begin to think about it in school not simply when they go into practice. so that we begin to get exposed. certainly when i was in school we practiced and were trained in largely a silo-based system rather than an interdisciplinary way. so that's one of the issues we'll be looking at. again, it's an important part of how we think about providers going forward. and then quickly going forward in the issues that have been raised, first there are the incremental kinds of changes. we've spent a fair amount of time this morning or this afternoon talking about payment reform, aimed at reducing costs and incentivizing changes in practice and specialty mix. the house passed sgr bill is still pending in the senate. again, it's a clear movement in that direction and that is towards payment reform and movement away

bloomberg foundations announced they're setting up a fund to help countries with the fight against big tob aco uruguay is one of the places it's being challenged. >> 80% of the packets are covered in warnings. rotting teeth sexual impotence, damage to the lungs and unborn baby. for uruguay they're part of the campaign that they believe saves lives. but the tobacco giants are suing uruguay for what it says are unfair trade practices. >> they are continuing with their own anti-tobacco measures but as we wait, thousands of people die. >> the man behind the recently elected president vasquez introduced the tough anti-tobacco laws in 2006, during his first term in office. the evidence he says that they're working and less uruguayans are smoking. >> i couldn't sleep, and i shook from it, but i did it. and i feel fine, and i want to live for my children. >> the city government runs this clinic to help smokers quit and stay off the tobacco. lydia, 21, started smoking at 12, and she started smoking at 13. >> i went five years without smoking. i quit smoke and can i started again, and i'm back here to s

if there is an aco model, it has to demonstrate that it can deliver the care.f there are cost savings, all the better. it doesn't presuppose that all the smart people are at the department of health and human services. it suggests that there are smart people practicing met us sin -- smart people practicing medicine. if they deny they have to tell group why it was denied. then, perhaps they can go back and recalculate. i would say, this will open up a new day. rather than having smart people over in cubicles at hhs deciding how to do payment reform, actually engage those who are delivering the care. host: we saw a headline on people reaching across the aisles on this doc fix. do you think you have the vote to move this this week? guest: yes is the short answer to the question. look, here is why. this is a chance to do something that ever since i got here 12 years ago, congress has been tried to do -- postpone problems related to the sgr. the fact that this will be once and for all removed, that's extremely important. a lot of bad policy has been attached to a fa

so since you gave me such a great lead-in -- [laughter] i'm part of an aco, accountable care organization called quality alliance. we have a region algae graphic scope. i'm here as a guest of dart, and my question for you is this: if health care can come together and we can get very creative in how we serve the populations both in getting them to the clinics proactively and building health care, decreasing expense, where do we start? having those conversations is a wonderful idea, very interested in doing that, but how do you get it started? so for the state of texas as an example, where would we start? >> well, you know we're asking that same question, and we recognize -- you hear this theme over and over, but you hear it because it's so true over and over again. it's not going to be the same starting place and ending place for the communities in texas as it may be for california as it may be for boston. one of the things that we have also launched is we have provided funding for system pilot programs, and i'm just looking to henry to make sure i don't push -- pilot programs oriented aro

and the aco contract is a deal between the group of providers and medicare. the savings industry succeeded that we will share in the losses. by the way, we will measure you on the 33 measures of quality. and we are going to adjust those payments based on your performance. on those measures of quality. so we have two years of public results and the pioneers beat the national benchmarks on which they are comparable national benchmarks and they beat benchmarks on four out of four patients experience measures for which we have comparable benchmarks and then the improved by the composite in the second year. for two years in a row that generated savings were up $284 million into the savings increased from 2.7 million in the first year to 4.2 million in the second year so they are organizations that are advanced and they have an experience in bearing the risk and delivering care in this new system of the reform. another model the partnership for patient is pretty patchwork of programs including some of our pay-for-performance to include care in the hospital. partner

in the affordable care act, there is, there are ways that a practice can be paid such as one of the aco models or bundled payments or patients under medical home. yeah those are available under the affordable care act, but the affordable care act does not ban fee-for-service. that still continues as it did before. but if there are special arrangements that people want to make they may make them. actually what this sgr repeal does is set actually that world actually exists in medicare as well. so if there is an aco model it's got to demonstrate that it can deliver the care and deliver the quality. and if there are cost savings then so much better. one of the things i like about the approach that we've taken, it doesn't presuppose that all of the smart people are at the department of health and human services. it suggests that perhaps there are some smart people practicing medicine. there are smart people at state medical associations and county medical associations. if someone can provide data on an alternative payment method, they're perfectly then able to bring that to the secretary of