Self-absorption is one way to stay focused. But, then again, as many a texting-while-walking person knows, it also can cause collisions with buildings or facial impacts with concrete — a phenomenon also known as falling on your face. Oops, that hurts.

Insurers are changing market dynamics, not waiting for outside forces to poke them with a stick. Humana, WellPoint, Aetna, UnitedHealthcare and many of the Blues are enthusiastic backers of physician medical homes in nearly every state. And there's even more activity around mergers, acquisitions and ACOs. You're in for a rude awakening if you expect insurers to just continue playing their good, old traditional role. Running time: 4:02.

We hospital folks are intensely focused on reshaping the system and how those moves will affect us. Everyone expects big changes — and probably rumbling turbulence. A recent KPMG survey of the top 200 system executives finds that 65 percent are expecting major changes in the next few years and 40 percent view their current business model as "somewhat sustainable;" 25 percent think it is "very sustainable."

I don't know about you, but that word "somewhat" leaves a lot to the imagination. I'd like to know what the "what" in somewhat is.

But we're not the only ones actively pondering our future and strategizing about what moves to make, and, equally, if not more important, what might move us up, down, sideways or off the board entirely.

The health plans also are sizing up their situation. The same survey showed that 53 percent of the health plan executives thought their business model was somewhat sustainable and 20 percent considered it very sustainable. They also see big changes on the horizon — more or less in line with the system heads.

The health plans have a lot to keep their eyes on. Look at Sears Holdings and Darden Restaurants. Each firm announced plans to give their employees a fixed amount of money and then allow them to choose their coverage from an online exchange. Workers can buy up or down, depending on their perceived needs. The new arrangement begins January 2013.

The announcement, which made the front page of The Wall Street Journal, set off a cascade of commentary. Some likened the change to the transition most firms made from company-provided pensions to 401(k) retirement plans controlled by employees and partially funded by the company.

Most experts agree it is a "fundamental" change. The exit of large employers from health benefits is a long-time worry of insurers. This doesn't qualify as an "exit" but it is an important shift. Some insurers see this as going mainstream quickly and are repositioning products to accommodate; others prefer the old wait-and-see approach. Whether it brings profits or pain — or both — is yet to be determined, but it is a big change in how the plans relate to a big customer base.

One thing is certain: It may not be a Market Mover right now but it is a very big Market Watcher event. Many important market influencers with the ability to act fast are waiting to see how this plays out. If they can lower costs without the employee managed care-type backlash of the 1980s, they will.

The health plans themselves are not standing around idly. Humana, WellPoint, Aetna, UnitedHealthcare and many of the Blues are enthusiastic backers of physician medical homes — now in almost every state. They like what they see clinically, cost control-wise and financially, and most are planning to expand. And much, much more is happening in the insurance arena from mergers, acquisitions, ACOs.

So if you are walking along counting on insurers to play their good, old traditional role, heads up; you could be in for a stumble.

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