. >> last question and i should have asked this of professor midic, we think about a state exchange here in california, what do you think the impact is going to be in terms of our topic about costs and i think as we went through the cpmc discussions, the only thing we agree on is everyone doesn't know what's going to happen. what do you think about it? >> in california you have a proactive value purchaser of health care. it can have a significant impact on in this market in terms of what it's going to demand of the participating health plan and the prices they have and the information they provide to their enrolled patients around helping and supporting them to make more economical decisions. the only way they're going to be successful is if they do that. there's going to be pressure on innovative network design and we've seen what they've come forward with for limited networks. >> could you see them as being the catalyst to cover california? >> i think in this particular state they can certainly be a strong catalyst for change. >> okay. thank you very much. next, we have profession or f