and we used the institute of medicine report along with studies from windberg and others as the basis for making the case for change in massachusetts. we also reasoned that we, blue cross blue shield and other insurers were the ones who purchased the care and we needed to demand change. we had for the first time data in the format and of the nature that would allow us to go to our providers and make the case for change. without being asked so, cleve, where did you get your m.d.? we believe that because of our brand, our members would expect that we would not contract with hospitals and physicians that we knew provided unsafe care or ineffective care. the data suggests that it's as much as 30% of the $13 billion we spend on care in massachusetts for our members may be of questionable value. and then, of course, there's a problem if you spend $13 billion and you pay 90% -- 93% of your claims, there seems to be a problem with that algebra kind of not acknowledging the 30% waste. it became clear that this was a problem that we as an insurer in the community needed to deal with. and, of co