eric de jonge. next to me is tricia neuman and eric de jonge, director of geriatrics and co-founder of the medical house call program at washington hospital center. eric will give us a glimpse of the independence at home program that is getting so much attention and that med star is planning to expand to other facilities. to my far left is jim garnham, director of contract and payment innovation at the university of rochester medical center. he leads rochester's bundle payment program. and he also has a hand in its aco and risk-based models. we're going to start off with cristina bocutte who will talk about the recent work that kaiser has done and what evidence we have on hand. >> thank you. let's see. okay. good. so i'm going to start with just a little context for delivery system reform in medicare and then i'm going to go over very brief summary of three of the models and conclude with a few thoughts onion going challen on thoughts and context. also cms had already been running some new models on

>> this is eric de jonge. i think independence at home can work in any area of the country, rural, suburban and urban. the challenge is how do you staff it. in arizona and new mexico, there's an ih life kind of home based primary care program that uses more televideo. these are slightly different staffings. the doctors are sometimes more consultants but you can achieve the same goals of keeping people at home, using mobile technology with a slightly different kind of staffing mix. but i think this can be done in any geography. >> just building on that briefly, this is an issue we focus on significantly. i think the primary care models can be done in rural areas. we did advanced payment, other methods in our program which had the vast majority in the last round of participants were small practices or rural practices to help with the transformation work. we also are engaging with a number of states that are thinking about population based payments for rural areas and what that might look like. more work to be do

i will turn it over to eric de jonge who will talk about house calls, independence at home program. >>ha