Additional to the ucsf dignity house our colleagues from mp c that share a commitment im submit across the board we have achieved the goal of length i didnt stay down closer to the 4 rage and another reduction on the pharmacy side weve talked about jen ice cream were 13 to but we need to do that and as ann marie said the subsets of patient that are very, very expensive if you shave 57 and 10 percent off by not achieving having a better clinic outcome and save thousands of dollars in the episodes of treatment those are the activities well put in place as i said the last 3 years have been a year of success across the board it is down 10 percent from we were a few years ago that is not down from an increase but an actual how many patient per population adjustorer had to be not limited to to the hospital our rate the er visit rates have gone up dramatically it is a Financial Result were not so proud of but we have to achieve those kinds of things to achieve that despite the flying costs of