I remember taking care of a patient as an obstetrician who was passing out for unknown reasons throughout her pregnancy and I wanted her to be evaluated by a neurologist and a cardiologist but I couldn’t get her access to the specialist because of her insurance which was quite heartbreaking I think a situation like this captures why a one-size-fits-all health care approach or model is in a lot of ways harmful. I see the difficulties that my own community has and I think that is pervasive throughout the United States a key component to solving the issues really has to do with empowering patients and providers to make their individual and unique choices. I think it’s critical and one of the things that I value about this project itself. The HOAP index is a tool for policymakers to take a look at their own unique environment state level and shine a spotlight on some very critical issues that are acting as barriers to patient care. At the policy level we can remove these barriers and improve the well-being of the patients around us. This doesn’t miss any of us and we need to positively address these challenges, be innovative and use the HOAP index so that we can have a better healthcare environment.