hospitalizations for duals were avoidable. in today's dollars that's about $8 billion. it is very poor care for patients obviously so we have a demonstration going on targeted at beneficiaries in nursing homes. so in closing, i couldn't be a bigger fan of trying to develop evidence-based models of care coordination and looking at prevention. an area that we have not been able to focus on are the preduals. so that the folks who are 45 to 64 before they're coming on to medicare there's a huge opportunity for us to do care coordination or medical homes or care management to improve their utilization and the prevalence and the intensity of the disease when they get on medicare. then the folks who are on medicare, there's a lot we could be doing to prevent their decline on to medicaid. and so far the financing and the incentives between the two programs haven't supported that work. i'm hopeful that once we get through dealing with the 9 million folks who are on the program we can really shift attention to the preduals and doing a much better job of managing i would say the p

cms study showed that 26% of hospitalsization for duals were potentially avoidable and today's dollar that's about $8 billion and it's very poor care for patientsobviously. we have a demonstration going on targeted at bisht yeeneficiarie nursing homes. in closing, i couldn't be a bigger fan of trying to develop evidence based models of care coordination and look agent prevention an area we have not been ablto focus on are the preduals. so the folks 45 to 64 before they're coming on to medicare, there's a huge opportunity for us to do care coordination or medical homes or care management to improve utilization andhe prefb lens and intensity of the disease when they get on medicare and those on medicare there's a lot to be doing to prevent decline on to medicaid. so far the financing and the incentives betweenworograms haven't supported that work and i'm hopeful that once we kind of get through dealing with the 9 million folks on the program we can shift attention to preduals and doing a much better job of managing d say the progression of folks to duel eligibility status. with that, i