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payer payeramp;#39;s an interesting space largely consolidated but a lot of i mean self-payers obviously going to someone like transparent whereamp;#39;s the competition come from for the large payers at this point well i think the large payers have to reinvent themselves many edna of course merge with cvs remains to be seen how that comes together and how that works cigna of course acquired express scripts so i think youamp;#39;re seeing the first stage in that but what big organizations do weamp;#39;ve seen this with some health systems they try to get bigger instead of trying to get better and so they have to fundamentally redefine their relationship with consumers health consumers number one providers number two both health consumers and providers generally dislike payers and itamp;#39;s hard to build a successful business long term if your primary suppliers and primary consumers dislike you and thatamp;#39;s where they are today so they have work to do yeah i see that on the
