Leaders Innovate; Laggards Comply

It also requires guts and a determination to innovate.

What we're seeing, despite all the complexity surrounding re-engineering a calcified, too-expensive, and needlessly unsafe healthcare system, is an obvious race to the lower-cost operating platform. That means you can't start from the assumption that if your costs are in check, you can negotiate harder.

What may be required, if your organization is to lead an accountable care organization (in the general sense) is pretty sophisticated coordinated care management expertise. This is not something hospitals have traditionally done very well.

That's why we're seeing so many new partnerships with disease management firms, academic medical centers sharing best practices, and any other type of collaborative partnership between the strangest of bedfellows.

These folks are not shy about blowing up their operating model and trying new things. Risk is inherent in such decisions. You're halfway there if you presume that in the future, the site of care is less important than making sure that care has the best chance of improving the patient's outcome.

Your attitude is important when deciding your approach to integration and care management and new contractual relationships with payers and other healthcare providers. The key question to answer, according to Keckley, is how ambitious should you be in putting the pieces together to integrate clinically. The answer hinges on how you view the threat or opportunity from taking on risk for outcomes.

As CEO, only you can answer that question. The only wrong answer is "I don't know."