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

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