ORLANDO — Mark Bertolini, president, CEO and chairman of Aetna, likely caught a lot of people of guard with his opening keynote at HIMSS14 when he described the future of an industry in which employers as buyers of health insurance — and likely his company's most lucrative customers — essentially go away.

The reason: Employer-backed care is driving inefficiency in the market. As consumers become the principal buyers of care, true reform will take place. And with patients in charge of health care spending, along with increased attention on the chronically ill and on wellness, much of the $800 billion a year misused in various segments of health care would be saved, he says. Much of that entails using technology to empower the consumer.

Bertolini is not a wonk, futurist or consultant and says he is seeking to creatively destruct the insurance game and is positioning Aetna to be in the middle of a change that's coming soon.

"This is the new model. This is the only model that works," Bertolini said.

That's heady stuff for a conference full of health IT geeks and vendors, and I'm guessing it spurred some conversation at dinners and drinks across Orlando.

But in the hospital IT trenches, they've got more immediate concerns and, unsurprisingly, a big one is money, according to HIMSS’ 25th annual leadership survey. Financial concerns rose to the top among the barriers to IT implementation, a shift from the last two years when the primary IT challenge was insufficient and untrained staffing resources.

More than 90 percent of respondents said that their organizations have qualified for Stage 1 meaningful use and three-fourths expect to qualify for Stage 2 this year. Almost all respondents claim that they’ll be converted to ICD-10 by October.

With money a concern and the battles over meaningful use and ICD-10 sort of winding down, getting a return on your investment from IT is gaining more attention. Lakeland HealthCare in southwest Michigan has devised a way to do that and estimates it has earned back $5 million of its $35 million investment, not including meaningful use incentives. Norma Tirado, vice president of human resources and health information technology at St. Joseph-based Lakeland, described the process it went through in a video interview.