PTAC | PTAC Recommendations Presentation | September 14, 2026 | 1/7

Good morning and welcome to this meeting of the Physician-Focused Payment Model Technical Advisory Committee also known as PTAC. My name is Dr. Chinni Paluto and I'm one of the co-chairs of PTAC along with Dr. Lee Mills. 2026 marks 10 full years of PTAC operations. The committee felt that this was the right time to reflect on all of the evidence regarding alternate payment models and value-based care that's been presented to PTAC through the stakeholders submitted Physician-Focused Payment Models and theme-based discussions over the years. Based on all of the information and evidence presented, the committee believes that the efforts of the CMS Innovation Center, the Center for Medicare through the Medicare Shared Savings Programs and other payers have made important progress in moving this nation towards value-based care. PTAC has drafted a white paper titled Transforming Healthcare Delivery Through Value-Based Payment Models and Care, A Roadmap. The paper articulates a roadmap for building on current learning and successes to further advance the development and implementation of APMs that support the transformation of the U.S. healthcare system towards a high-value, patient-centered care. In the paper, PTAC offers recommendations that focus on total cost of care, PCOC models, and strategies to accelerate the adoption of value-based care. PTAC's recommendations are based on information that's been discussed and shared at PTAC's prior public meetings. At this public meeting, we brought together various experts to provide their input and feedback on PTAC's draft white paper. Before our first session of the day, we are very honored to have opening remarks from Mr. Abe Sutton, the Director of CMS Innovation Center and Deputy Administrator at CMS. Mr. Sutton, prior to assuming his current roles at CMS in January of 2025, served as a principal at Rubicon Founders, where he co-founded two health service companies, Honest Health, which focuses on enabling primary care physicians, and Evergreen Nephrology, which focuses on enabling nephrologists. From 2017 to 2019, he's also served at the National Economic Council, Domestic Policy Council, and the Department of Health and Human Services. In these roles, he coordinated health policy across the federal government with the focus on value-based care and increasing choice and competition in healthcare markets, as well as updating the federal government's approach to kidney care. Welcome, Abe. Thank you, Dr. Pallour, Dr. Mills. Thank you to the entire members of the Physician Focus Payment Model Technical Advisory Committee for the invitation to join you this morning. It's a privilege to be here with you, both those in person and those joining online. Thank you for having me back. Now, the last time that I joined PTAC for a conversation was in June, when we discussed patient safety and how it connects with CMMI's models and our strategy. Today's conversation is different in scope, but it builds directly on that. We're here to talk about the committee's draft white paper, a document that pulls together nearly a decade of PTAC's work into a single vision for where value-based care should go next. We can all agree that this question, where we go next, matters more than ever because the status quo is not sustainable. Healthcare is on a track to consume roughly one dollar out of every five in our economy, while outcomes remain elusive. PTAC and the Innovation Center have different roles, but a shared task to bring forward promising ideas, test them rigorously, move ahead only when they improve care, and protect the federal taxpayer. That's the spirit within which I want to engage in today's conversation with the paper, highlighting the broad areas of overlap and also a few places where our thinking diverges. Before I get into the paper itself, I think it's worth naming how we got it. Over the last 10 years, across 36 physician-focused payment proposals, recommendations on 28 of them, and more than 250 expert presentations before this body, PTAC has built a rich body of evidence and independent judgment that few institutions in this country can match. In September of 2025, this committee focused on patient empowerment. In February of this year, it shifted focus to multi-payer alignment. In June, we talked about patient safety, as I mentioned earlier. These are all threads that run through every Innovation Center model. This white paper effectively draws these threads together. When I respond to it today, I do someone who has been on this journey with you, who's watched these ideas develop, meeting by meeting, and is a partner in the same long-term project that we share, move Medicare from paying for value to paying better health, better outcomes, and better value. When we think about the future of the Medicaid program, the implications of this paper for them, that's the spirit in which I engage today. To start, there are broad areas where we are in agreement, which is not surprising. It's really most of the paper. We agree with the call for continued commitment to value-based care. To us, that means continuing to iterate, testing, learning, revising models, rather than treating any one model as finished prior to certification. We also agree that stable, predictable benchmarks matter. Organizations need confidence that the ground won't shift under them year by year in order to invest in prevention. We have worked closely with our colleagues in the Office of the Actuary at CMS in the design phase to try and produce stable benchmarks that won't need to be updated year over year and won't need to see large changes. Building and learning from past models and working to not build in features like retroactive trend adjustments that left participants feeling like a rug was being pulled out from under them. We see real promise in nested, episode-based accountability, the kind of design that is reflected in the CMS-administered risk arrangements, building specialty-level accountability into a broader total cost of care model. The transformation cannot only be about organizational-level total cost of care. Complementary, physician-focused models can test outcome-aligned patients, coordination with primary care, and bring more clinicians into accountable arrangements. Access is one example of that. It pays for measurable outcomes in technology-supported chronic care, creates a co-management pathway with referring clinicians, and complements ACOs and other risk-bearing arrangements. We also agree that accountable care must work for people with the most complex needs. LEAD, our long-term enhanced ACO design model, is designed to integrate high-need patients across ACOs, including people who are duly eligible or homebound. Kidney care is another area where tailored accountability, earlier intervention, and coordination across settings remains essential. We support the paper's call for entity-level, balanced portfolio approaches to measure performance with a clear and transparent link to payment. We also recognize that rural providers need a distinct path. A head pairs state or sub-state regional accountability with prospective hospital global budget and primary care investment. The Rural Health Transformation Program, run by CMS, supplies state-level investment in workforce, technology, and infrastructure. One is not a substitute for the other. Capacity investment can create the on-ramp, but payment reform has to make that capacity sustainable for the long run. The committee's recommendation to empower ACOs, the way Medicare Advantage plans are empowered, resonates with us. The Part D premium buy-down feature in the LEAD model is a concrete step in that direction, and we see room to build in this direction further together. We've already taken action to revise a MAHA-specific, HICIA-style award to MAHA Elevate, which is designed to accomplish the very goals referenced in the paper for a HICIA-style award. And we see it as meeting the moment inspired by the vision and clarity that Secretary Kennedy has brought to how we should all be engaged in preventive health efforts. And we also agree that, in real time, usable health data is essential to shared decision making, purpose limited to improving a patient's health, and that model design must anticipate a rapidly evolving technology landscape. The goal is not more data or newer tools for their own sake. It's information that helps clinicians act earlier. Patients make informed choices, and payment follow outcomes. There are two principal areas I want to call out where we think about things slightly differently than the approach laid out in the draft paper. First, how to expand participation and move providers into meaningful downside risk. And second, where to place accountability while preserving rigorous evaluation. I welcome dialogue on whether we are getting these aspects right and where the committee thinks about them differently. On the call for new on-ramps around upside only and mandatory ACO for participation, we think we're already addressing the same underlying goal, but through a different pathway. The lead model is designed specifically for organizations that risk-based models historically haven't worked for, without crowding into lower risk ACO space that the Medicare Shared Savings Program and the alternative APCM codes were ready to serve. In 2025, the Innovation Center undertook our model portfolio and concluded that our primary care portfolio was too crowded and confused potential participants about which model to join. By operating fewer models in this space and designing them intentionally around the needs of distinct populations and practices, we aim to simplify the entryway. On the mandatory ACO suggestion, I want to offer an alternative solution to this problem. Geo ahead or geographic ahead is designed to move us towards the goal of having all of Medicare beneficiaries in an accountable relationship without requiring a mandate to get there. Geo is an acknowledgment of where many primary care physicians are and attempt to pave a pathway to get to full accountable relationships without destroying the fee-for-service option as a way to practice. I understand the goal of a mandatory ACO model and I understand what it's trying to solve, but I think there are other options that we should test before moving in that direction. In terms of the recommendations to place accountability at the organizational level, with some flexibility in how care is delivered, I also understand the logic there and it is reflected in many of the models that we design. We sometimes choose to place accountability at an individual level and constrain delivery flexibility because doing so protects our ability to evaluate a model rigorously. That's a deliberate operational trade-off and I won't pretend it always sits comfortably alongside priorities with this program around model design, but it's one that we make with the valuability design in mind. This evaluation versus participation operations trade-off is one that I'm fairly confident if we sat down with any of my predecessors they would talk about how that was a significant factor in model design. This type of trade-off needs to be made in the design of practically every single model that we have produced at the center and it's one of the hardest decisions. I raise these similarities in two areas of differences to highlight the high degree of natural alignment between the committee's vision and the active work underway at the Innovation Center today and also to identify the places where I think further conversation helped enrich our thinking. This alignment was already evident to us from prior meetings such as the committee's findings on patient empowerment last year and how the multi-alignment multi-payer alignment findings in February are visible in models such as AHEAD. So as we spend today in discussion around the paper and going into detail on it, I want to leave you with this. We are aligned with the committee on the fundamentals that there is an urgent imperative to find a better path for American health care and value-based care is essential to that path. That stability and predictability matter as much as ambition and that patients deserve real ownership over their data and their care. Thank you for the work that you have been doing for the work that went into this paper and thank you for the opportunity to respond to it today. I look forward to the discussion. Thank you for sharing those remarks. We appreciate your support and engagement and we look forward to continuing to collaborate with the CMS Innovation Center. For this public meetings agenda we will have four sessions focused on obtaining expert input on PTAC's recommendations on value-based care that are laid out in the committee's draft white paper. We are very excited to welcome diverse experts from academia, organized medicine, provider and care organizations and other industry sectors to share those perspectives. PTAC's draft white paper and other materials related to this public meeting can be found on the public meeting registration site and on the meetings page of the ASPE PTAC website. I also want to mention that tomorrow morning will include a public comment period. Public comments will be limited to three minutes each. If you would like to give an oral public comment tomorrow but have not yet registered to do so, please email PTACregistration at NORC.org. Again, that's PTAC, P-T-A-C registration at NORC, N-O-R-C dot org. Following this public meeting, PTAC will prepare a final version of its white paper to submit in a report to the Secretary of HHS. As a federal advisory committee, PTAC will base its final white paper and recommendations on information that's been shared or discussed at the public meetings. PTAC's final white paper will be posted on the ASPE PTAC website. I would also like to note that, as always, the committee is ready to receive proposals on possible innovative approaches and solutions related to care delivery, payment, and other policy issues from the public on a rolling basis. We offer two potential submission tracks for submitters, allowing flexibility depending on the level of detail of their payment methodology. You can find information about submitting a proposal on the ASPE PTAC website. At this time, I would like to invite my fellow PTAC members to please introduce themselves. Please share your name and organization. If you would like, feel free to share any opening thoughts regarding the two-day public meeting. I'll start. I'm Chinni Kalu and the Founding Chief Medical Officer of Agentic Healthcare Incorporated, which is committed to building a unified patient record as well as enabling and empowering patients with agents and agentic architecture. It brings trustworthy information interpretation as well as professional assistance to enable the healthcare consumer to use agents for engagement and navigation and empowerment when navigating the healthcare system. I also work with Stellar Health, which is a value-based care aggregator and have prior history with the largest independent multi-specialty group in the country as well as Walmart. Next, let's go to Dr. Lee Mills. Good morning. I'm Lee Mills. I'm a family physician. I currently serve as Chief Medical Officer of Better Health of Oklahoma, one of the states where you manage your Medicaid plans. I started my career coming through operational primary care and health system leadership, where I had the privilege to operate and lead five or six different CMMI pilots over the years. I spent 10 years on the health plan space, deeply involved in value-based contracting and models, and currently leading the way through a state mandate under statute to increase primary care spend from 4% to 11% of total dollar spent only through value-based contracting. Walter? Good morning. My name is Walter Lin. I am an internist and founder of Generation Clinical Partners. We are a medical practice focused on the care of the seriously ill and chronically complex living and near living, primarily nursing homes and assisted living facilities. We have a long history of value-based participation. I currently serve as the Chief Clinical Strategy Officer of LTCACO and also a medical director of a PACE program. I'm also on the board of the Post-Acute and Long-Term Care Medical Association. Lindsay? Good morning. I'm Lindsay Botsford. I am a family physician in Houston, Texas, where I continue to care for patients and serve as the Regional Medical Director for the Midwest in Texas for Amazon One Medical. In that capacity, I've served as the Chair of the Governing Body of the One Medical Care Network and ACO Reach participant for the last five years, which has generated consistent savings each year. I also wear the hat as the Chair of the Board of the Texas Academy of Family Physicians, where I'm the immediate director. Christian? Good morning. Christian Ramachandran, Chief Information Officer for UnitedHealthcare's Operations and Experience Division. I've been in healthcare for 24 years, serving in executive roles as a payer, provider, and technology organization, 15 years of which has been in furthering value-based care from the incentive model creation, the alignment work on the payer side, and the care delivery side, actually embedding value-based care principles and furthering it, as well as in technology. Now we'll go to our virtual member, Josh. I'm Lauren Harden. I'm Notes by Training and Chief Integration Officer for HC2 Strategies. As a former co-chair of PTAC and a long-term member, I'm really excited for our meeting today. It's a collection of a lot of insights and valuable evaluation and reflection on what's working. My background includes innovation in hospice, children's hospice, and palliative care in serious illness. I developed a complex care model in the Trinity Health System that scaled across HC2, really focused on reducing risk and increased quality delivery. I was part of the team that started the National Center for Complex Health and Social Needs, a dependent coalition that worked for eight years with states, payers, communities, providers, designing models and approaches for complex health relief. Now with HC2 Strategies, I partner with states on innovation and value-based payment at the state level, Medicaid 1115 and Medicaid innovation and delivery, and many, many different cross-sector approaches. Thank you, Lauren. Sorry again. Now to Josh. Good morning, everyone. Joshua Lau, Internal Medicine Physician and National Associate Vice President for Chemical Transformation at Ascension, where I oversee enterprise remote patient monitoring, patient-reported outcomes and engagement campaigns, including those that encompass the care of Medicare, Medicaid, and other value-based care populations. I spent, you know, 10 to 15 years doing a number of different things in the value-based care space, including generating what I hope has been foundational evidence to inform bundle payments and how they interact with ACOs, and we do population outcomes. I currently also serve as a commissioner on the Medicare Payment Advisory Commission. And like other committee members, I'm excited about the conversation that's going to unfold over the next few days. Thank you all. Three of our committee members, Dr. Larry Kuczynski, Dr. Hinesh Bansal, and David Tyson were unable to join us for the September meeting, but we want to acknowledge their great work on this committee. Now to Lee. Okay. Now let's move to our introductory presentation. PTAC members, you will have an opportunity to share any additional comments after the presentation. The committee has collaborated closely with staff to prepare for this meeting, and I will share some background information regarding PTAC's 10 years of operations and provide an overview of PTAC's draft white paper and recommendations to set the stage for today. So first, operational background and experience. PTAC was established to review stakeholder-submitted, position-focused payment models, PFPMs, against specific criteria established by the Secretary of HHS. And within this context, PTAC also reflects on pertinent team-based topics regarding effective payment model innovation and PFPMs and alternative payment models. PTAC holds public meetings to review PFPMs and associated topics, and PTAC subsequently prepares and submits its comments and recommendations from these public meetings to the Secretary of HHS. PTAC was, as you know, created by Medicare Access and CHIP Reauthorization Act of 2015. PTAC was comprised of 11 active members who served terms typically three years in length, with some variation. PTAC has comprised 27 individual national experts over its 10 years of operations. PTAC typically holds quarterly public meetings, with its first public meeting held in February of 2016. PTAC produces a report to the Secretary of HHS with recommendations related to each PFPM proposal or theme-based topic, and all such reports are posted on the ASPE website. To best inform its review of PFPMs and theme-based discussion topics, PTAC does a variety of things. First, it does an in-depth background research and environmental scan to set the context. It conducts supplemental analysis as needed out of the Medicare data set. It requests expert input, either through presentations at the public meeting or written and oral feedback options. All materials produced by PTAC are posted on the ASPE PTAC website, including PFPM proposals, environmental scans, supplemental analyses, written public comments, the expert presentations we've received, reports to the Secretary, and the public minutes of meetings, transcripts, and videos. Over its 10 years of operations, starting in 2016, PTAC has held 32 public meetings. We've received 37 PFPM proposals and deliberated and voted on 28 of the remainder. Eight were withdrawn by the presenter, and one is under preliminary review now. We've had 16 theme-based discussions, topics explored, and 238 experts providing input at PTAC's meetings. Some characteristics of the stakeholder-submitted PFPMs. They are submitted by a wide variation of stakeholders, including national provider associations or specialty societies, regional or local single specialty physician practices, academic institutions, and other stakeholders. They've focused on specific health conditions, provider types, settings, or some with broad applicability. The main approach to payment for care delivery in these PFPMs has been per-beneficiary, per-month payments, and shared risk, or episode-based shared risk, or additional payment structure. The theme-based discussion topics have been related to value-based care and issues in previously submitted PFPM proposals have covered a wide variety of topics, including telehealth and virtual care, care coordination, social determinants of health and health equity, background and components of population-based total cost of care, best practices and care delivery models, payment model features, specialty integration, care transition management across sites of care, rural participation, performance measures, patients with complex conditions or serious illness, pathways to maximize participation, as well as methods to reduce barriers to participation in patient total cost of care models, data and patient empowerment, multipayer alignment, and most recently, patient safety. Now, moving to the white paper with recommendations for value-based care. PTAC is truly uniquely positioned to provide recommendations about APMs and delivery system transformation. PTAC has considered all the evidence, both qualitative and quantitative, presented to it over the last 10 years of operations, and produced concrete recommendations related to value-based care. Realize that as a federal advisory committee, PTAC's recommendations must reflect topics that have been discussed at open public PTAC meetings. PTAC's recommendations pertaining to stakeholder-submitted PFPMs and theme-based discussion topics have been submitted in individual reports to the Secretary of HHS. And finally, PTAC has summarized its recommendations related to the specific payment models in the form of issue briefs that have also been posted on the ASPE PTAC website. So, PTAC has summarized and consolidated all of its experiences and testimony heard in a draft white paper titled, Transforming Healthcare Delivery Through Value-Based Payment Models of Healthcare Roadmap. And the purpose is to articulate a specific set of recommendations or roadmap for policy that further incentivizes and supports the transformation of the U.S. healthcare system to one that produces high-value patient-centered care. The assumption is that PTAC believes it is most prudent to use what has been learned to date as working, and to evolve and refine efforts to implement these value-based payment models, indeed to accelerate and lean into these efforts to scale value-based payment and care across the delivery system. PTAC is today seeking input on its draft white paper at this public meeting as it continues to refine its recommendations. The final white paper will be published later this year on the ASPE PTAC website. PTAC presents 22 recommendations across nine discrete topic areas, including looking back and moving forward, three recommendations about total cost of care as a vision for patient care and population-based models, three recommendations on a payment approach, maximizing participation in total cost of care models, two recommendations, performance measurements, three recommendations, enablers and flexibilities in total cost of care models, three, total cost of care models in rural areas, two recommendations, two recommendations about technology-enabled care AI and patient empowerment, and then three final recommendations involved in patient safety. Let's get into it. First, looking back and moving forward. PTAC holds that accountable care organizations, the principal TCOC model in the country today, are achieving savings that are growing over time. Stakeholder presentations to PTAC suggest a broad acceptance and willingness among stakeholders to adopt accountable care as the model for moving into the future. Recommendation number one, policy makers should continually reinforce a sense of urgency around and commitment to value-based payment and care as the principal policy tool for transforming the healthcare delivery system. Next, total cost of care as the vision for patient care and population-based models. Recommendation number two, shared vision of high-value patient-centered care should be the foundation for policies intended to transform the delivery system. Success factors are multiple and include team-based care, patient-centered care, care coordination and well-coordinated care, patient empowerment, risk mitigation, disparity reduction, and connection to resources for health-related social needs. Payment methods and performance measures should continually evolve to reinforce the standard vision of care. Recommendation three, organizations should have accountability in total cost of care models that should also have the flexibility to design incentives down to the provider level. Recommendation four, accountable entities should have flexibility in how they manage and organize care. Now we'll pivot to recommendations about payment approach. PTAC holds that financial incentives and APMs should reinforce the care delivery model. Meaningful payment amounts are critical, particularly for primary care providers treating high-needs patients. That leads to recommendation five. CMS should continue to make progress in establishing benchmarks to create long-term predictability for payers, health plans, and accountable entities. Recommendation six, some portion of payments should be made prospectively to provide financial predictability and enable investments in infrastructure needed for the transformation of value-based care. Recommendation seven, for clinicians and organizations new to value-based payment, clear, predictable, simple, multi-year glide path should be implemented to enable capacity building and ensure the vision is well understood moving forward. Now we'll pivot to maximizing participation in total cost of care models. The PTAC holds that maximum provider participation in total cost of care models is essential for effective delivery system transformation. Payment models should promote transition to value-based care while also ensuring financial stability for stakeholders. That leads to recommendation number eight. New pathways are needed to encourage greater participation in total cost of care models among independent practices, rural providers, integrated delivery systems. Recommendation number nine, CMS should develop models to incentivize integration of high-value specialty care with advanced primary care. Now, recommendations related to performance measures. PTAC holds that current measures do not adequately capture the desired performance characteristics for total cost of care models. When high-value measures are needed, patient-oriented measures are especially important for high-needs patients. This leads to recommendation number 10. Performance should be measured at the level of the accountable entity in total cost of care models. Recommendation 11, measures used in total cost of care models should be a balanced portfolio that reflects domains such as clinical quality, population health outcomes, patient experience, and others. In recommendation 12, performance measures should be linked using transparent methods to payment at the level of the accountable entity in total cost of care models. Now, pivoting to enablers and flexibilities for total cost of care models. PTAC holds that to enable, encourage, and maximize participation in value-based care, CMS should, recommendation 13, continue efforts to provide real-time patient-level claims data to accountable entities in total cost of care models. Recommendation 14, use its leadership position to help public and private payers align both their commitments to value-based care and payment and their methods for implementing these strategies, including risk adjustment and performance measures. Recommendation 15, provide accountable entities with Medicare-directed waivers and flexibilities similar to those in Medicare Advantage to ensure accountable entities can achieve the vision for care under total cost of care model. Now, moving to total cost of care models in rural areas. PTAC holds that increasing the adoption of value-based care in rural care areas is critical and that rural areas face truly unique economic, social, and environmental challenges that can adversely affect participation. Recommendation 16, multiple strategies are needed to encourage rural participation in total cost of care models, such as providing upfront payments to yield the capital to support adoption of health IT and other infrastructure, and establishing longer glide paths for taking on risk. Recommendation 17, rural providers should be encouraged to collaborate with other providers in their area to aggregate the volume of patients under value-based payment model. Now, moving to technology-enabled care, AI, and patient empowerment in total cost of care models. Recommendation 18, patients and their clinicians need access to real-time usable patient health data to promote patient engagement. Digital tools should be used to help promote data collection, sharing, and integration, and AI and other new technologies should be used to synthesize data in order to produce actionable insights to support provider-clinician decision-making, identify changes in patient health prospectively, and to personalize care. Recommendation 19, through both payment methods and performance measures, APMs should strengthen incentives for providers to use the vast amounts of usable data to generate actionable insights in our patients through shared decision-making at the point of care, and that models should also incentivize patients to participate in shared decision-making and engage in health promotion activities. And our final domain, patient safety, CTAC finds that despite improvements to date, medical errors remain a very significant problem in health care. Leading to recommendation 20, significantly increased incentives to improve patient safety should be emphasized in new and current APMs that strengthen through new performance measurement and payment methods. Recommendation 21, CMS should consider developing a patient safety-specific model that includes incentives for new methods of reducing patient harm, such as investing in new information systems, changing system level culture, and producing greater transparency. And recommendation 22, CMS could or should initiate a new version of health care innovation awards for ground-level development and implementation of patient safety models. Conclusion, so the data on published ACO outcomes to date have not quantified the impact beyond simple economic results expressed as cost savings. We understand that very significant changes in care delivery and innovation of care have resulted from these models that have really not been fully quantified yet. There should be a shared vision for value-based care that's widely expressed and understood. Total cost care models need to move beyond the current ACO model payment structure and be the primary vehicle for value-based care. Focus on total cost care models should be on providing value to members, patients receiving care, and incentivizing and maximizing participation of organizations that are well-equipped to provide value-based care but continue to find fee-for-service more attractive, and that providers that need financial and other assistance to make investments in value-based care. So next steps, at today's public meeting, PTAC has invited multiple esteemed experts to share their thoughts on PTAC's draft white paper, including overall assessment of the paper, its value for policymakers, the range of topics and recommendations we've covered, the wording and tone of the recommendations for a broad audience, whether any recommendations should be strengthened or sharpened or alternatively made less prescriptive, whether any relevant recommendations should be included, and whether any other pertinent information should be included. Realize and understand that PTAC's recommendations are based on topics that have been publicly discussed at PTAC public meetings, and additional items shared today may become topics for future PTAC meetings and or lead to recommendations in the report. So PTAC members, great set of recommendations, great founding for today's discussion. Any follow-up comments you would like to share? Also indicate your tag flipped up. Adequate time for a broad discussion. Any comments? Okay. If none, it's time we will have a break. We'll plan 1040 Eastern time. Please join us then if we welcome our first group of experts for our first session to discuss PTAC recommendations for white papers. Thank you, and brief break.