So who is in the best position to drive the necessary changes in healthcare? There are many perspectives on that question. Is it the purchasers of healthcare like employers, private insurers, Medicare or Medicaid? Many would argue that as the one spending the money, they are in the best position to demand change. And there are many opinions on if that change is effectuated through improved consumerism and transparency or through new payment models and care delivery models. What about the providers? Providers want to continue to control their own destiny. However many are resorting to consolidation and acquisitions as their solution. They argue that bigger is better, and with more scale, they can invest in more sophisticated infrastructure and better coordinate care. Unfortunately, the past does not provide a positive outlook for the future in these circumstances. New payment models like ACO shared savings, bundled payments, and patients in their medical homes are in some ways pitting doctors against hospitals with strong incentives to avoid costly hospital services. New technology like telemedicine, electronic medical records and data exchange, wearable devices, and other services provided in outpatient and home settings present further opportunities to keep care out of hospitals. Employers and purchasers are fine with this, but are providers? It is also worth noting that hospitals are dangerous places with high risk of contracting infections. It is a failure of the healthcare system when a patient is treated in the hospital or emergency room, rather than in an ambulatory setting or at home. Hospital leadership needs to understand where all of this is going, and reinvent their business model to remain viable. Wasteful care, which is being targeted for reduction and elimination, quite often represents revenue and profits to hospitals. They need to embrace new payment models and new care delivery models and reassess where they can earn revenue and profits. The more proactive providers can be, the better chance they have of withstanding the changes that are happening. At the same time, employers, Medicare and Medicaid are not going to just wait for the providers to affect the necessary changes. They are aggressively implementing benefits and transparency tools that engage their employees as better healthcare consumers. They are driving the payment model changes and setting expectations about the results that should be achievable. Sustainable change requires a multi-faceted approach focusing on new payment models, care management, data analytics, and information sharing, as well as insurance benefits and consumer engagement tools. In many cases, there may be increases in cost like primary care services, behavioral health services, or prescription drugs. But they will be more than offset by reductions in spending on hospital and specialty services. Ideally, all stakeholders within a geographic area are engaged in affecting the necessary changes to improve healthcare cost and quality. But, any change requires vision and leadership. We want to continue to follow the money. If the goal is to reduce the amount of money spent or to improve the value achieved from a consistent level of spending, then the stakeholders that can deliver those results should see long-term success. [MUSIC]