these markets will have a positive impac positivet. impact. the theory being given the fragmented delivery system, the, vertical integration with health plans and pharmacy benefit managers has the potential to provide a more holistic approach on health care is managed,w th coordinated and delivered. however, given the track recorde of consolidation within thisare industry, most employers are skeptical that they will seeveme improvement from these mergers over the three to five year horizon, and some employers believe cost will increase. additionally, 70% of respondent believe new market and trends from outside the deliveryou system, or outside the healthh care industry in general, including innovations in silicoe valley fory emp employee allias are needed to disrupt health poa care in a positive way. this reflects a level ofation frustration by employers with the pace of change on improving health care today. i will add that this questionng regarding new entrants into thed delivery system was not as result of the jpmorgan, berkshire hathaway a