Some health care professionals passionately believe that the Affordable Care Act is a misguided crusade by the Obama administration to redraw the medical system according to its own image. They hold out hope the Supreme Court will dismantle the entire statute or at least its foundational principles when the justices issue a ruling on its constitutionality this summer. Even if the court fails to rule against the ACA, critics of the law are optimistic that a Republican takeover of the Senate, and perhaps the White House, in the fall elections will spell its doom.

The flaw in that thinking emerged last month at a meeting of the American Health Insurance Plans in Washington, D.C. Representatives of some of the nation's most powerful insurance companies made it clear that no matter what happens on the federal side, they will move forward to implement many of the changes called for in the ACA and by the Centers for Medicare & Medicaid Services.

"Health care reform could die tomorrow and it wouldn't change a thing," The Fiscal Times quoted Alan Muney, chief medical officer at Cigna.

For those who demand that health care transformation be driven not by government but by the marketplace — well, that's just what's starting to happen. Though concepts like pay for performance, bundled payments, accountable care and medical homes may have been hatched by policymakers, they've now been embraced by the private sector, and executives insist there will be no turning back.

Blue Cross Blue Shield of Illinois and Advocate Health System teamed up to embed 60 care managers in physician practices to oversee patients with chronic diseases, closely monitor patients discharged from hospitals, send case workers to patients' homes to make sure they follow discharge instructions and even encourage end-of-life advanced directives when appropriate, The Fiscal Times' Merrill Goozner reported. A year later, Advocate's per-patient costs were down 6.8 percent compared with spending that stayed flat across the region.

Results like that are a powerful incentive for payers — public and private, alike — to press providers to adopt similar tactics.

Most hospital executives and boards understand that the health reform horse is already out of the barn. Affiliations with other providers abound. Physician relations are being strengthened. Nurses' roles are expanding. Population health is the new imperative. The patient experience, not just patient satisfaction, is now a priority. Data collection and analysis are becoming much, much more sophisticated.

True, making care delivery more coordinated and outcomes-oriented to improve quality and contain costs is just half of the reform law's intent. The other half is expanding coverage, and much of that depends on the requirement that most Americans have health insurance. Among other things, the individual mandate underpins the state exchanges, which are intended to provide competitively priced insurance.

But whether or not the individual mandate survives to its intended launch in 2014, it's clear our health care system is undergoing dramatic, permanent change spurred as much by the market as by the government.

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