How many health insurance providers are doing that?
SS: Virtually all of them now. The top 50 cover a vast swath of America. They have pilot pay-for-performance, medical home and bridges to excellence programs in place. State governments are voting on pay-for-performance initiatives. There is a lot more going on than people realize. There is increasing momentum around this dynamic of payment reform. That is a big part of what we are tapping into. There is a real opportunity for physicians to lead performance. They can lead it, and there is a payment structure which rewards them for outcomes. In the past there was not a payment structure to reward physicians for leading disease management, nor did they have the capacity to do it. Two things have changed. Payment reform was the first. The second is that now we have technology solutions such as automated messaging systems. These technologies have been vetted and tested. In essence, we can leverage those technologies to extend the reach and influence of physicians. This is a real change in
