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all right I think weamp;#39;re going to go ahead and get started this afternoon Iamp;#39;d like to welcome everyone for coming both all both all of you here in the audience and also those of you who are watching online like to thank all of you for being here and itamp;#39;s great to see such a great response from folks who are here in the audience and also from those who are online and I think itamp;#39;s really a reflection of the importance of this issue Iamp;#39;m Clarence Lam Iamp;#39;m the chief resident of the preventive medicine program here at Johns Hopkins Bloomberg School of Public Health and today weamp;#39;ll be talking about the all payer system here in Maryland and I think itamp;#39;s itamp;#39;s really an important issue for a lot of us is particularly with increasing health care costs and hospitals being asked to do more to coordinate care and play a central role in a lot of the affordable the provisions of the Affordable Care Act and with the exchanges coming