. >> hi, i'm david, i work with whitman walker health.nd i'm happy to say that we're often the anti-cascade remedy. you know, we do terrific work in the community, the hiv community, lgbt community. we're moving toward being a patient-centered medical home. huge expense. no money out there to help us get there. we have issues where community-based organizations that have sound business models suffer at the hands of one organization or one entity changing a policy. on one medication we went from a reimbursement model to a replenishment model, and it's taken almost $900,000 out of our operating budget in two days. who is out there working across agencies saying, you know, as we move towards aca when everybody has to compete on quality, you can't disrupt these business models and expect people to not be impacted all the way through the care continuum. >> you raise a very good point, and i think one to have realities that we know about the affordable care act is that everything's not going to be perfect when it's implemented on day one. and o

. >> hi, i work with whitman walker held and i'm happy to say they were often the anti-cascade remedy. here we do to a thick work in the community. the hiv community, lgbt community and we work towards a huge expense. no money out there to help us get there. we have issues where community-based organizations that have some business models suffer at the hands of one organization or one entity changing the policy. on one medication we went for a reimbursement model to replenishment model and it's taken almost a hundred thousand dollars out of our operating budget in two days. who is out there working across agencies, same as we move towards aca what everybody has to compete on quality, you can't disrupt these business models and expect people to not be impact it all the way through. >> you have a very good point and i think one of the realities we know about the affordable care act is not everything will be perfect when it's implemented on day one. i'm not .. these people need to be engaged. i encourage you to be doing more on the policy side. a lot of these news stakeholders that are c