i am katie merrell. and the paper in today's issue of health affairs. the work was funded by the commonwealth fund. this is the third of product out of this project it would be more going for a couple of years. before i start i want to make a point. larry casalino start a slide is a key point. we share one thing which is we've given more talks in university of chicago for anyone else. you never get past the first slide there. so the whole talk on the first light at the university of chicago, you guys seem to let us proceed. i don't know. i don't know what to do with that. larry, you worked out well and i will follow your example. what i was going to say before you interpt, was payment incentives are going to shape the prevalence of the model by which my providers, the pairs and the attractiveness of patients. it's going to affect the evolution of the market medical homes take off, what they look like in five years is going to really matter how we pay for them this year and next and the year after. going to affect was on those teams, what the tabs are an

i'm katie merrell and the paper that's in today's issue called structuring payment is my co-author bobparents at the thurgood institute and it was funded i bet paramount fun. and this is the third how i got in this bigger project for a couple years. he forced her to want to make a point. larry castling those started with key points and i'm starting to decide this is key points. we share one thing which says we give more talks at the university of chicago university of chicago than enough and you never get past the first by their peers of the whole talk is on the first night at the university of chicago. i don't want to do at that. very calm election were to die while i'm a publisher and example. what is going to say my whole talk in two minutes before you in about, was that payment incentives are going to shape a prevalent in which we take a pipe providers, payers and the attractiveness to patients. and it's going to affect the evolution. what a medical home takeoff, what they look like in five years is going to really matter how we pay for them to share and make sure that you're after

monthly payment, whether it's a small marginal one or a bigger primary care one, how did you get me, katie merrell to silenuses as your guy and promise to never go see somebody else and you're getting a few bucks a month as my medical home, i need to honor that too, and i need to not go see him, no offense. but if if we don't figure out what the accountability is on the patient's side and if the mechanisms that get created don't suit the patient, then there's still going to be a demand for troy if they aren't integrated into part of the answer and you're going to get a bunch of money for no reason and i'm still going to go see troy. so to me, there's a canary in the coal mine, about what they're getting, whether they'r getting it or not and whether they become part of the new integrated system or not, there's going to be demand or not depending on how the new mechanism suits the needs that they are currently getting. >> i might add to that, that the -- you know, 50% of the kids and 60% of the adults don't have a primary care doctor, so there's a huge medical homelessness out there, and we can act