CHICAGO — Everyone is maneuvering into a position of strength in the new world of health care — be it payers, pharmacists, hospitals or doctors — while still paying the bills in the old one. What's the biggest obstacle standing in each organization's path, and is it the same from field to field?

Experts from all four areas chewed over that question during a panel discussion this week at HIMSS15, hosted by health care giant McKesson. We all know the health care cliché: one foot on the dock — the old way of doing business by tallying a high-volume of visits — while another foot is in the boat pointed toward avoiding hospital stays and keeping patients healthy.

James Whitfill, M.D., chief medical officer with Scottsdale Health Partners, took the analogy one step further. For the Phoenix-based, physician-hospital organization, the transition is like having one foot in two different canoes, both traveling down a roaring rapids while trying not to tear in half. From the doc's perspective, the biggest thing keeping those two canoes from converging is the lack of trust between any combination of hospitals, providers, payers, patients and employers.

"I don't know about you, but I think some of those relationships could use a few group hugs," says Whitfill. "Trust is a big issue and, if we're going to solve this, we need to have trust among those parties. Alignment of incentives helps to build that trust, but there's going to have to be a putting down of the old adversarial relationships, historically. We have to figure out new ways to work together."

Of course, this being HIMSS, all conversational roads seem to lead to the pressing need for interoperability. Steve Stanic, chief information officer for Mississippi Baptist Health System, says his biggest roadblock is the inability of various health IT systems, owned by disparate hospitals or physician groups, to speak with one another.

Stanic says establishing a unique identifier for every patient, used seamlessly between hospitals and insurers, is the "holy grail" of getting to real interoperability. He believes the health care system will reach that destination when the dollar does because, right now, the conversation ends when it means that a doc practice has to pay $10,000 so his own electronic health record will speak with that of a partner hospitals, rather than the hospital ponying up those dollars.

"It suddenly doesn't become that important," Stanic says. "My belief on value-based care is that it will become full-blown when the dollar gets there. Right now in Mississippi, we still have a lot of fee for service."

For Derek Weiss, R.N., a vice president with insurer Cigna Corp., the biggest challenge is overcoming the transactional, linear view on which health care has been built in this country. "That's a sea change," he says. Similarly, Tim Wright, CEO of Wagner Pharmacy Co., says breaking the fee-for-service mindset ingrained in doctors is a huge hurdle. That and teaching "health care geniuses" like docs who are "IT buffoons" to use new tech tools at their disposal.

"My dad and I get along great, but he could not accept that everything he knew was wrong," Wright says. "I think that's going to be a huge challenge for the modern health care worker, especially those who have spent a lot of their career with this one mentality … . Health care workers need to be willing to adapt to new things and keep an open mind."

What does your hospital see as the biggest obstacle to value-based care? Share ypour thoughts in the comment section below, or email me at