Sometime in the next couple of months, we will know the fate of the Patient Protection and Affordable Care Act. The Supremes — as they are affectionately called by policy wonks and talking heads — either will toss the whole thing out, keep it all intact, or dismantle major sections. Your guess is as good as mine. And while the court's decision, along with the November election, will have ramifications on the entire health care industry, those political events are unlikely to stop sweeping changes that already are under way.

As my colleague Bill Santamour noted in this space&nbsp last month, "Representatives of some of the nation's most powerful insurance companies made it clear that no matter what happens on the federal side, they will move forward to implement many of the changes called for in the ACA and by the Centers for Medicare & Medicaid Services. 'Health care reform could die tomorrow and it wouldn't change a thing,' The Fiscal Times quoted Alan Muney, chief medical officer at Cigna."

Bill went on to point out that insurers are rapidly adopting new payment models that embrace value-based purchasing, forging ahead with accountable care and medical home models, and linking with providers of all stripes to create a new paradigm.

I'd suggest, though, that insurers aren't really the drivers here, rather they are the vehicle. The ones putting the pedal to the metal are employers. In this month's Interview (page 30), IBM's Paul Grundy, M.D., notes: "Large corporations in this country are the buyers of care principally for the 65 and younger population. We play a unique role. And, frankly, most of us have been fed up with the value proposition of the care that we buy. We get it when we see a sign on the freeway that reads: 'We do the best heart surgery.' That sign says to us, 'That's where the money is and we're going after it.' We don't want to buy that anymore.'"

I saw Grundy, who is an advocate of the patient-centered medical home, speak at a conference earlier this year and he said that major employers, such as IBM, are increasingly factoring health care quality and costs into their strategic business decisions. Why open a plant in Community A when health care costs are twice as high as those in Community B and there's no discernible difference in quality?

But it's not just those 30,000-foot-level decisions that are being impacted. As Towers Watson and the National Business Group on Health  found in their 2012 health benefits survey, leading companies are providing employees with more and more information about health care service pricing and quality. And, these firms plan to "improve provider quality by offering specialty treatment or narrow networks, and providing incentives for the use of evidence-based care."

Clearly, as they continue to rebuild from the Great Recession, businesses are looking for every competitive advantage. Curbing health care costs is top on that list. It's also worth pointing out that the Tower Watson/NBGH survey contained this nugget: Fewer "than one in four (23%) companies are very confident that they will continue to offer health care benefits 10 years from now, down from a peak of 73% in 2007." Talk about driving change. But that's for another column.

Let me know what you think. You can reach me at