All the experts said it would not happen, that it could not happen, that the President could not do what he just did. Most of the experts haven’t read the Constitution. Most of the experts get paid to tell you what you want to hear. Most of the experts have a vested stake in incremental change, not seismic shifts.

The “now what” is this: health systems have to learn how to compete for the business of consumers, just like every other part of the economy. I know, I know, you certainly have lobbyists or are a member of an association that will sue to stop the President, or at least slow him down, but that tactic will ultimately fail, just like it did with diagnosis related groups and BBRA 1997 and HCAHPS and Core Measures and readmission penalties and Certificate of Need. But this is bigger than anything since DRGs…

The race starts this morning, and the first question is this: are you going to watch the avalanche, or you are going to start skiing? If there was ever a time for first mover advantage, it is now. When an avalanche starts, survival is all that matters, and the strongest and fastest skiers have the best chance…but sometimes they don’t make it either.

The next question you should ask yourself and your fellow executives this morning is whether your health system knows how to compete. Not whether you have billboards on interstates and in airports or whether you are sufficiently obsequious to the medical staff or whether you have marble walls in the lobby or whether you pretend that MyChart is the same as patient engagement, but whether you know how to compete for the business of consumers based on price and cost and quality and convenience, i.e. value. Compete like Amazon competes with Wal-Mart, and GM competes with Ford, and Apple competes with Google and Microsoft…and how HCA competes with everyone else. Do you know that competing requires that you know who all of your competitors are and how to identify the consumers that are valuable to you, and how to communicate with them, and how to influence their behavior?

Do you want to survive the avalanche? Can you ski fast enough?

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