It’s tempting to attribute all the tumult in health care today to legislation and regulation formulated in Washington, D.C. For sure, the Affordable Care Act and the various reforms perpetrated by the Centers for Medicare & Medicaid Services are formidable and must be reckoned with. But the dramatic evolution now underway in our industry is being driven less by government mandate than by private sector demands.

The real forces behind it are the American public and providers themselves who understand that cost growth is an unsustainable burden on the nation, and by employers and other payers who want more bang for their health care buck.

The steamroller that is health care transformation will rumble along no matter who controls Congress or how the Supreme Court rules on various aspects of the ACA.

To get a better sense of this new health care dynamic, the American Hospital Association and Health Forum earlier this year invited representatives of hospitals, payers, employers, retailers and the capital markets to Williamsburg, Va., for a frank discussion.

As you’ll see in our special report — inserted between Pages 8 and 9 — nobody came wearing rose-colored glasses. All the panelists agreed that the path forward is still largely uncharted and there will be more than a few bumps along the way. Speaking of the move from volume to value, Nancy Agee, CEO and president of Carilion Clinic in Roanoke, Va., put it bluntly: “It’s going to be chaotic. It’s not going to be a pace of change that’s slow or fast.”

Take heart. The report from Williamsburg and the other articles in this issue of H&HN offer plenty of real-world examples of how hospitals and health systems are finding their footing amid the uncertainty.

Three of the articles are final installments of year-long series:

• In the wrap-up of his series on new models of care and payment [Page 30], Howard Larkin examines successful ways four different health care organizations are embracing population health. Example: North Shore-LIJ Health System has set up an around-the-clock call center for its at-risk patients. A real human being answers within six seconds and provides or finds the answers to questions about appointments, prescriptions or clinical issues.

• In "The Boomer Challenge" finale [Page 36], Paul Barr presents six case studies of providers that are using innovations in facility design, information technology and other areas to meet the needs of this aging — and always demanding — generation. Example: New Hanover Regional Medical Center's community paramedicine program trains paramedics to provide preventive and consultative care in patients' homes.

• Marty Stempniak brings his patient engagement series to a close [Page 42] by spotlighting how providers from Memphis to Minneapolis are partnering with a wide array of community organizations to enhance wellness, prevention and access for local residents. Example: Allina Health found that collecting data was not enough to assess the social needs that affect health in its neighborhoods. So it teamed up with the local Cultural Wellness Center to set up Citizen Health Action Teams that bring residents together on a regular basis to pinpoint problems, find solutions and evaluate progress.

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