The Impact of Value Based Care on Patients

I think we've, we found ourselves in another cyclical pattern which shouldn't be all that surprising to all of us. There are going to be organizations that do really well on that cycle. And then the question coming back to your preface comments to this question Brian is, what is actually going to be the impact on patients from these cyclical things like does anything actually change? I don't know that the average American consumer has better health care experience and they did a decade ago.