my name is brian marcotte, i'm ceo of the national business group on health. welcome to the breathing on her 2019 health care strategy and plan design survey results of large employers. this is, you have a pack of data, executive summary thatry will help you follow along with my remarks. i will comment on the survey results for about 20 minutes and then we can open it up for q&a. national business group winhelp is a membership-based-b organization consisting of roughly 420 or so companies.. 74 of the fortune 100, and these are large multistate come in, many cases, global employers who typically self-insure theirare o health care costs in tsthe us .. and they contract with healthany plans and pharmacy benefit managers to manage networks anda to pay claims on their behalf, most of them are self-insured. business groups mission is really to keep our members on the leading edge of innovation,h thought and action when it comes to the delivery, the financing, the consumer experience and thee affordability of the health care system. we also look to really accelerate

host: brian marcotte joining us for this discussion. bloomberg reported yesterday that general motors negotiated directly with the detroit employees to offer smaller costs. what do you think of that? guest: we see a number of companies going direct and select markets and increase from 3% to 11% in this year. it becomes a very surgical strategy for companies. in aeed critical mass market. you need a willing provider group that you can partner with to create something more reflective of the needs of your negotiate and then, the standards and guarantees and agree on target -- it is a lot of work. you are seeing companies take this in a couple of markets but it is not something they can drive across the country. members are multistate employers that have a bandwidth to take that model and go market by market. they leverage their health plans to do that but we have a number of companies and that is growing , that are picking certain markets and going direct. and they can be more nimble than possibly a health plan can be in creating a network