While debate rages on Capitol Hill over “repeal and replace,” only limited attention has been directed toward reforming the current “fee for service” model. Indeed, both the Affordable Care Act (“ACA”) and proposals for its replacement focus primarily on the reach and cost of providing coverage for health care, rather than specifics for the delivery of health care. With almost 18 percent of U.S. GDP spent on health care, experts see consolidation and alternatives to “fee for service” as fundamental to reducing costs. Integrating care coordination and delivery and increasing scale to drive efficiencies allows organizations to benefit from shared savings and relationships with payers and vendors. Deloitte forecasts that, by 2024, the current health system landscape—which includes roughly 80 national health systems, 275 regional systems, 130 academic medical centers, and 1,300 small community systems—will morph into just over 900 multi-hospital systems.