When local healthcare officials talk about the state of their industry, they say a perfect storm is brewing. Kevin Poorten, president and CEO of KishHealth System, and Michael Flora, executive director of the Ben Gordon Center, said providers work together to ensure people who need care get it, even as demand increases. At the same time, providers are in the midst of what Poorten calls an unprecedented shift in how healthcare is delivered in the U.S. on the backdrop of financial challenges. There's the federal Affordable Care Act. And at the state level, there are proposals to cut billions from the Medicaid program and discussion of taking away the tax-exempt status of hospitals.