The setting was ironic yet appropriate for a panel discussion about just how much and how quickly U.S. health care is changing. There we were in Williamsburg, Va., with its loving re-creation of a bygone era, talking about an industry on the threshold of a shiny new one. One overarching question animated the proceedings: Are hospital leaders clinging to a quaint but soon-to-be obsolete view of health care or are they finally alert to the many forces reshaping their world?

The panel discussion and the conversations surrounding it covered a lot of bases, from the long-term viability of nonprofit health care to the probability that freewheeling entrepreneurs are right this minute dreaming up innovations to upend care delivery even more dramatically than it's already being upended. We'll report on those discussions over the next several months here in Hospitals & Health Networks and in our e-newsletter H&HN Daily.

A major theme that emerged in Williamsburg is the growing impact of health care consumers. Experts have been telling us for some time that as consumer-directed, high-deductible health plans proliferate, individuals will begin to shop for care in much the same way they shop for other products and services. They'll weigh quality, reputation, customer service and, perhaps above all, price.

On Page 44 of this issue, Adrian Slywotzky, who co-moderated the Williamsburg panel discussion, describes the urgency for providers to become more consumer-friendly, in part by compiling a health care "hassle map" to chart — and then alleviate — all the steps, wastes of time, delays and frustrations consumers must endure to access care.

He warns that health care leaders may be slow to notice the impact of consumerism because it began modestly and is only now picking up steam.

A couple of weeks ago, I posed a question to readers in an H&HN Daily blog called "Can We Disrupt Health Care Even More?" To my surprise, a lot of the replies addressed the disruptive role consumers already are playing with this year's launch of the insurance marketplaces. Responding on LinkedIn, Wayne Caswell summed up that viewpoint:

While electronic health records, remote monitoring, accountable care organizations and the patient-centered medical home are positive steps, "even more important in my view are the new incentives that consumers have to take responsibility for their own health and wellness," Caswell wrote. "I see that trend as adding new competition across the entire health care delivery system, starting with the ability to easily compare Bronze, Gold and Platinum plans on the insurance exchanges."

To help consumers seek out the best value, Caswell continued, "insurers are pressuring providers to make their once-secret charges more transparent."

Price transparency was the topic of H&HN's June cover story, which looked at several different ways leading-edge hospitals and health systems are helping patients and payers understand up front what their care will cost.

I wonder how many of the hospital leaders reading this now are mired in a quaint but fading health care universe and how many are preparing their organizations to thrive in a fast-evolving new reality. Are you?