1-Think about the ultimate customer, the employer group, not Aetna or any other intermediary: how and why would an employer with people in many locations spend any time with VM? Remember most employee groups are mutlti-state with many locations, besides Seattle.

2-For the employer group, determine how to add value to the employer group. VM needs a solution that helps the employer group in all locations to be of value to this customer. Perhaps a JV with Aetna, or any of the many other companies that now specialize in scientific collaboration to determine and implement value to the employer group in all its locations.

3-avoid the legal morass of state insurance regulation by not using capitation, which limits innovation to a state by state basis.

4-Fortunately, paying providers for health care is not insurance and can be done nationwide, tomorrow without sate insurance department regualtion with self-insured groups (about 125 million people).

5-another perhaps unconvetnional but very practical thought–remember Medicare is only 20% of health care, and very political and very regulated — thus it may be prudent to ignore it and leave it for later, in Phase II, when Medicare wants to follow your innovation.