Jean Drouin, MD, MBA. CEO and Co-Founder of Clarify Health Solutions (San Francisco). "The same economic realities remain very much in effect. Paying for the new plan will require significant savings to be generated by providers. Those who get ahead of the curve and vigorously reshape how care is delivered locally will be the big winners because they will end up with the most compelling products and services to offer to employers and commercial insurers, who will continue to be the major sources of margin for hospitals for the foreseeable future. Learning to generate positive margins at Medicare rates will be essential, as the high-water mark for survival will rise as providers increasingly compete with each on price."