the answer to your question is the shared savings component of that model it breaks down the silos and there's a potential for saved sharings from reducing hospitalizations, reducing er visits, reducing complications of chronic illness that result in expense like die yal sis. if you only look at the shared save information the medical home based on the physician services, there's too little skin many the game for the physician. but if the shared savings model looks across the silos then there's a win-win for the physicians making the effort that the medical home -- >> do you think there's potential? >> absolutely. it's a game changer. >> mr. chairman, isn't accountable care organizations isn't that to address this? that we put in the health care bill? >> partly. but at a more global level. that's at a system wide integrated delivery system. i'm talking really down at the level of supporting the primary care that's necessary for high functioning system whether it's in an acl or separate. >> mr. chairman, i think what both to have doctors were talking about is the independence of home mo

silos you might not be here april. ain't none of us never promise said tomorrow. if you died you would need a will. that way you control your nickel when you are gone. get your ducks in a row you might not be here come april. yeah, your policy is up-to-date and we will pay say if you lose an arm at the elbow at the mill. if you died you need a will. double pay for accidental deaths we have you down. your wife will not need to borrowo. you might not be here come april. being alive is enough to get you killed. do you hear about the folks in monroe? if they hang you from a tree you need a will. your folks won't have to worry about a meal with this insurance when that day of sorrow come. silos you might not be here april. if you died right sudden you'd need a will. >> this next is titled no one's real high button. >> beat, beat, beats here the sound of the train on the georgia road the claps of wheels at the gaps of the joints of the rails the beat of the hammer on iron andan vil at the smithing. shaping shoes for mules an

avalos: i think we want to make sure that we are working -- that organizations are not working in a silo. that other organizations share their concerns around violence and have the research to respond. there needs to be a network that is set up where people are communicating with one another about what they are seeing on the ground and how people can protect themselves. that would be icy or working with the rec and park department. or the icy working with the family resource center. we need to see this response to we know people are getting on the same page about what is happening and what they can do as organizations within the neighborhoods. >> right, and i would like to highlight that we do have neighborhood coordination meetings where that dialogue exists. it is not immediate. we rely on the directors of every program to communicate when every, died -- a homicide does exist. but we're definitely looking to create tighter network. that is what it sounds like you're suggesting. supervisor avalos: i think that we have so many services that are sharing similar goals and rolls in the neig

it's about silos follows a fishing riggel in the shallows. he describes the line in his tablet as much pride in that line as a man and his son. he giggles and goes on. the next letters come easy. with this he will have more than a mark to bind. rambling across the page again and again in messy rows along it flows until he goes off the page's edge. he smiles. he's surprised to hear when his mouth opens. that's mine. so, this really lovely book that georgia put together for me has great painting on the cover. a painting of mcintosh street in georgia painted in the 1940's by a man, frank stanley herring. i

and secondly alternative models must cut across medicare silos. when physician care achieves overall medicare program savings the physicians and medicare should share in those savings. currently additional physician services that prevent costly medical care drives deeper cuts under the sgr. this incentive structure has to change. physicians have already begun transitioning into alternative payment and delivery models. this includes for example 154 of medicare accountable care organizations and the center for medicare and medicaid is testing many new models. many innovations are also being conducted in the private sector as the committee heard at its june roundtable. ama strongly supports these initiatives and is helping physicians with the transition. for example our ama convened physician consortium for performance improvement as developed measures relating to outcomes and overuse of care and is expanding its work in this area. congress can take immediate steps to help in the transition. first congress should require cms innovation center do offe

and as we move to that, it doesn't necessarily fit within the payment structures or silos of payment. so we have to look at alternative payments which is to my second point, and that's where we propose replacing the sgr with a value-based update which says let's pick a target. we want to improve cardiac care this way, and it's not just the cardiologist, it's the primary care, it's the cardiac surgeons, it's anesthesia, pulmonary, everyone who touches that patient will be involved in incentives that that's the target we want to get to, and let's drive to that target. so i think we're becoming more patient-centered. we're not quite there yet, but we think replacing the sgr with something that actually is patient-driven targets, does it get to eight to ten years? i hope so, but it may take us eight to ten years to even get to that point. will it be something else 12 years from now? we're always evolving this, so i'm not going to say this is forever. >> that's a fascinating question. anybody want to respond to that? yes. >> well, i'd like to respond to the patient-centered part. i agree c

. -- siloed at the department level. the way dph defines a person might be different from another department. when they develop these matrices that measure trends over time, they are not getting -- it is good information, but our information, we are putting in the effort to make sure -- it is a definitional issue. enough to make you care your hair out. we have been working on getting these definitions consistent across departments. >> thank you so much for the great work. i would like, to conclude, to call up chief still to give some closing remarks before opening up for public comment. >> thank you very much for having the hearing today and giving us the opportunity to highlight some of the really great things going on in san francisco, as well as some of the challenges, and point out, this will be on the website at the end of the day, a report of the san francisco adult probation. basically the first six months of realignment and impact on our department. we have provided copies. our next report will be at the 1-year m

keep in mind that none of these agencies and individuals you are hearing from our operating in silos. they are not just talking about specific neighborhoods. they're talking about public safety from a citywide approach, which is kind of what my role is here in the mayor's office, to take the city wide approach to a lot of these issues. while also specifically addressing some of the issues that were raided the -- raised in the ingleside neighborhood where shootings have gone up. there has been an uptick recently with shooting and with homicide as well. other agencies will talk about that. but i do want to keep a perspective that although we are still in overall loans in terms of the numbers, this is something the city takes very seriously and the agencies he will hear from will take this -- to take this very seriously as well. supervisor avalos: related to where you address that, but i want to make sure it is very clear, so i will say it separately. this hearing is geared toward involving people in the community. and we have a lot of people here in that -- from the community today. we

, how many physicists are there with you in the silo.hink they judge that the physicist wasn't as useful to national security in the post cold war era as before. you won't read that in the report. that's my interpretation of that sequence of events. no other particle accelerator had been cut that had been proposed and built for the entire 20th century. >> do you believe that if we had continued along the path of funding these kinds of big scientific projects it does make a difference, because the knowledge accumulates here, the people accumulate in the united states and there is a kind of spillover effect? >> oh, yes, it is more than spillover. in fact i call it a fly wheel. when he take on projects of such magnitude -- by the way, in the big picture that budget is small compared to the -- >>al cultural subsidies -- >> exactly. okay? it's small. let's just balance our understanding of this. so when you do this, every step that you make in the engineering, in the physics, is on the frontier. when you're on the frontier, you discover thing

there was a vision we needed to do better regional planning instead of our silos in communities. on different projects like the interoperable radio project funded through rf funding. we're getting to know each other as people and in the roles we have a today so that when the big emergency hits, we will be able to pick up the phone and say, i need this or that. working with our partners in fema, nancy and i have had a number of conversations about how we can work together to pull together resources. it is not enough for the federal government to give us the framework or for the state to give us a framework or for the local communities. we need to all be doing it together. one thing that is really exciting to me is i was admitted to the national preparedness leadership institute at harvard. i am part of " for -- i am part of cohort number 8. my project at harvard was working with folks around the country and people at fema as well. we're trying to put together a template for local communities to respond that will hopefully be complementary to the ndrf. we're hoping it will be such

decades-- and i've been in higher education for decades-- people told me why don't you break down the silos, why don't you have department x and department y. we're not going to have departments on this campus. we'll have areas of concentration based on the city's economy that we're calling hubs. >> rose: president obama, first lady michelle obama, al hunt and david skorton when we continue. captioning sponsored by rose communications from our studios in new york city, this is charlie rose. >> rose: on thursday, july 12 of last week i went to the white house reporting for cbs news to talk to president obama and the first lady michelle obama. we talk of many things, both political and personal. we also went outside on the balcony to talk about vacation. first the balcony and then later the conversation inside in the blue room with the president and the first lady. not a bad place to live. >> you know, it is gorgeous and... the humidity went down a bit for you, charlie. >> rose: you got a basketball court, a tennis court, a fountain. you can see the washington monument. >> i just always remin

we have many computing silos world wide connected to us and that would also give a fantastic way of connecting into the rest of our computing system bird fight you mentioned hundreds of russian researches working in cern what was the role of russian scientists in the experiments on the hadron collider. it's a very prominent one the russian scientists have contributed to the hardware of the experiments they have built for all of the four big experiments very important components which are which and use now and now they have two parties and they will participate in the analysis of the state or two and the stent more about the early universe to understand more about the microcosm and for this i think such a computing center planned the coach out of in situ and i just visited it and i think you have a fantastic opportunity there would be fun would be great for the scientists in russia says iraq dieter ho at a director general of the european organization for nuclear research spotlight will be back shortly right after a break sell them don't waste their leader. hold it. hold it hold. of. her mother

. >> did you see that silo and old barn?s about 120 years old. >> reporter: all those years,. >> this golf course made it that much tougher every day referring to trees being this high verses 100 feet high now. >> reporter: and now eagle's nest wants to grow more because of the economy they have had to readjust their shot through the trees. >> i think golf courses would probably start marketing to women, probably in their best and long term interest. >> reporter: they got a -- you don't like golf how about swimming? how about tennis? >> i like to play. very no problem playing with the guys but i like to play with girls too. >> reporter: what women want i place where they feel kids are safe and having fun. a room where daughter dear sir grow up and get married a golf prowho never had a bad day. >> try not to. that's for sure. >> reporter: i take that back. mike's worst day was the worst day he lost his wife to breast cancer and how the club rallied behind. >> she is here. >> reporter: the course started on the backs of people

now this is one silo, one unit that blew up at j.p. morgan, and j.p. morgan has trouble elsewhere. the way to look at this isn't in the context of the size of j.p. morgan, but the size of this unit. >> now in terms of the profit that is j.p. morgan reports, it should be reporting profits. it has a $2.3 billion profit sheet. the profits toots reporting relative to the size of their balance sheet are not big. >> tom: clearly not a fan here, janet. j.p. morgan said he'll restate the first quarter as a result of the trading loss. material weakness is a quote from the release, and taking steps to remediate the problems. clearly you are not satisfied that the bank has a handle on this, let alone the culture that led to this trading loss. >> tom, what has been refeeled in the press is embarrassing detail after embarrassing detail. taken as a whole, it adds up to an utter failure of corporate governance. jamie dimon has a sarbanes will oxley issue. he signed off on statements saying the management was adequate and corporate governance was adequate, and the unit that reported to him was for

they arer ha very siloed and everything is top down, right, people aren't from the bottom coming from ideas, it was one guy, two guys. >> i believe the new apple facility has some of the same design elements included, so -- but, you know, pixar and apple are very different cultures, so we have this idea of evaluating this chance and ideas from anywhere is part of a culture. >> i just wonder if there may be some -- i don't know, what your idea of how creativity works in a company like apple where maybe they are sort of thinking about and trying to make their own luck without some of these collisions that occur. >> collisions can happen a lot of different ways. you talk to any great scientist and they will tell you they had a, you know, slow hunch when it came to their great breakthroughs, some book they read, some conversation, somebody they've met, that ended up in their head, in their brain, fermenting, right, colliding with other ideas, and some point down the road, they had their breakthrough, so apple, absolutely, allows its large workforce to have creative collisions, but in diff

i learned that a lot of the conversations we have about our neighborhood and community happens in silos. we have folks only talking with visitation valley. we have folks in bayview only talking with and a small corner of the bayview merchant quarter. we don't have people talking to the potrero hill association. all of these different fragmented conversations are happening. there largely talking about the same thing, crime, keeping streets clean, businesses, supporting small businesses, maintaining and making sure the city is livable for everyone. no one really looked to their neighbors. they stayed within their neighborhood, but did not reach beyond the boundaries. that is one thing i saw that i actually made a concerted effort on the campaign to build bridges. for me, that goes beyond the neighborhood. it goes to connecting the southeast to the large part of san francisco, wake up, we're out here. we want bike paths, dog parks, open space. we no longer want to have a neighborhood or a reputation of a crime-filled community. the other thing that i learned is really, we are all human. ho

federal government to do these demonstration projects, but the funds have been-in the past, at least-siloed, so that they could only address one or the other at the same time. i think one of the reasons that the demonstration grants have been separate is because, indeed, the insurance financing has also been separate, and it's an important thing to keep in mind. there's also another issue that we also have to keep in mind that we're addressing with our screening brief intervention referral and treatment. while it is true that the issue co-occurring is the expectation, not the exception, for those who present the treatment, the majority of the people who have substance abuse problems or mental health problems don't present for treatment. so 95 percent of the 20 million people who meet criteria for substance abuse perceive no need for treatment. in other words, they're not in the treatment setting. so, if we look at integrated treatment, we're looking at people who tend to have more co-occurring, because a larger group of individuals actually don't meet criteria for co-occurring. and so as we

south this government in the courtroom is internal responsible the responsibility of separating the silos rest squarely on the shoulder of this government that we are i think it's over it's going to be my you should know that the united states played a very important role in seeing the south get it independently and i mean let's be very very this is a fact ok western they are a very important role in seeing that happen ok maybe they did not separate the south they did not the south it was a sudanese decision and it was this government that wanted to get rid of the cells so that the north and arab and islamic part. of the arab world this is a government that work from day one to separate this out ok mommy why behind you want to jump in this is crossed out u.k. i had yes i just wanted yes yes i just wanted to clarify to america that i didn't see that this is asian of south sudan is their responsibility of the west or to us cause no you didn't you say that no no no no no no no i didn't really hear i didn't say that is. saying. we are tired i decide i'm going to school this is a theory that t

and secondly, alternative models must cut across medicare silos. when physician care achieves overall medicare program savings, physicians and medicare should share those savings. currently additional physician services that prevent costly medical care drives steeper cuts under the sgr. this incentive structure has to change. physicians have begun transition into alternative payment and delivery models. this includes for example, 154 medicare accountable care organizations and the center for medicare and medicaid innovation is testing many new models. many innovations are being conducted in the private sector as the committee heard at its june round table. the am, a strongly supports these initiatives and is helping physicians with the transition. for example, our ama convened physician consortium for physician improvement has related methods for outcomes and overuse of care and is expanding its work in this area. congress can take immediate steps to help many the transition. first, congress should require cms in the innovation center to offer oppo

the colors everywhere, flags on mailbox, even the silos in the middle of the field. -- >> made byamericans, for americans. >> reporter: all the way back to the civil wars, world wars i and ii. and that moment on the moon? >> one small step for man. >> reporter: saluting that flag on the moon. >> that was ours. yes, sir. >> reporter: proud of it? >> very proud. >> reporter: tonight, we learn that sales at annin are up nearly 20% over last year. so, americans are now looking at those labels, just like that family in utah today. changing one flag at a time, three worlds at a time. made in america. and that is the broadcast tonight. we leave you with another image. this one from new york. that flag, made in america. for diane and all of us, happy fourth. good night. captioned by closed captioning services, inc.