A decade ago, pundits were beating the drum about “bigness,” saying things like: “You need to get bigger.” “You need to have scale.” “You need local market dominance to matter.”

Similarly, healthcare leaders were told: “This is the only way to get to value.” “This is the only way to successfully invest in the technology required by a slew of new regulations.”

This advice – increasing scale to be successful – was only ever a half-truth. “The Answer,” merging with other health systems to gain local-market control and effectively negotiate with payers to preserve their rates, was only ever useful in enabling market-dominant healthcare organizations to game the system.

A retrospective look through the historic lens of healthcare made it seem like getting bigger was a reasonable solution. On the surface, it appeared to work. But what it didn’t do was address underlying industry problems, nor consider the very dynamic and different business model that was evolving behind the scenes.

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