When Geisinger Health System looked deeply into its women's care service line, particularly for perinatal care, it didn't like what it saw. Leadership didn't have to go far for ways to improve, however.

Whether or not the Patient Protection and Affordable Care Act is ultimately repealed, many of the drastic changes taking place in healthcare today regarding strategy, composition of assets, and even the business model are already under way.

Incentives for cutting costs are starting to line up, and physician productivity has never been more critical. Providers have been experimenting for years with telemedicine as a substitute for office-based visits. But it had not progressed much past the experimental stage—until recently.

Providers who have successfully achieved stage 1 meaningful use can attest that the effort is challenging, and they offer some lessons learned.

Treating groups rather than individuals requires patience and significant investment. But the payoff makes the effort worthwhile, hospital leaders are finding.

Health systems are adding freestanding imaging centers and aiming for around-the-clock coverage. At the same time, they are being pressed to reduce extravagant and unnecessary imaging costs and to improve patient outcomes.

Christopher Searles, MD, has many titles. As a family practitioner and psychiatrist, he codirects a residency program for University of California, San Diego, medical residents that operates out of a large homeless shelter and clinic.