As a field we are still on the journey from volume to value. The emphasis on the integration of value-based care into payment reform efforts will increasingly affect all stakeholders. It will drive movement toward a common set of metrics that will constitute the value and quality provided. It will require a comprehensive data strategy to assess performance and analyze different risk-sharing models and ultimately move to enhanced models of care.

— MaryJane Wurth, executive vice president, American Hospital Association

  • Particular emphasis has been placed on pursuing competency-based board selection; more precise executive succession practices; broader attention to director refreshment mechanisms such as tenure, term and age limitations, and fitness-to-serve policies; assuring an equal distribution of labor across board committees; assuring a sufficient number of directors to address the increasing demands of the enterprise; and greater engagement between the board and the leadership team.1
  • More than half of U.S. counties — all rural — have no practicing mental health clinicians.2
  • Provider ownership of health plans has been increasing steadily. Between 2010 and 2014, the number of providers offering one or more health plans grew to 106, from 94. In 2014, these plans were available in 43 states with an enrollment of 15.3 million; an increase from 12.4 million in 2010.3
  • Growth in ACOs established by hospitals and systems has been continual since 2011, the first year data were collected, moving from 6 percent to 25 percent in 2014.4
  • Violence puts an economic burden on the entire health care system and society. The CDC estimates that the direct cost of violence for nonfatal injuries totals $5.6 billion per year, with indirect costs totaling $64.8 billion in lost productivity. The Urban Institute estimates the cost of firearm assault injuries for U.S. hospitals is almost $630 million annually. Hospitals are increasingly identifying violence prevention as a community health need.5,6
  • Nearly all health systems will require clinicians to follow specific treatment pathways when caring for patients who are using certain high-cost therapies.7
  • The shift from fee-based to value-based payments, say survey respondents, is the single biggest challenge facing U.S. hospitals and health systems, affecting institutions across every region, size, location and type of ownership.8

2017 AHA Environmental Scan

Download the complete 2017 AHA Environmental Scan PDF sponsored by B. E. Smith.


  1. Health Law Reporter Outlook 2016, Bloomberg Law, Bloomberg BNA, Jan. 2016
  2. “Top Health Industry Issues of 2016: Thriving in the New Health Economy,” Health Research Institute, PricewaterhouseCoopers, Dec. 2015
  3. “The market evolution of provider-led health plans,” McKinsey & Company, Gunjan Khanna, Ph.D., Deepali Narula, and Neil Rao, April 2016
  4. AHA Hospital Statistics 2016 edition, Health Forum, 2016
  5. “Hospital Approaches to Interrupt the Cycle of Violence,” Health Research & Educational Trust. March 2015
  6. “The Hospital Costs of Firearm Assaults,” Embry M. Howell and Peter Abraham, Urban Institute, Sept. 13, 2013
  7. “Pharmacy Forecast 2016-2020,” ASHP Foundation, Dec. 2015
  8. “Executive Summary of a survey of 300-plus hospital executives,” The Economist Intelligence Unit, Nov. 2015