As health care moves from fee-for-service to value-based medicine, and, eventually, to population health management, imaging is facing the imperative to redefine its role in the care continuum. “We’ll be focused closely on value and outcome measures in the environment we’re calling imaging 3.0,” says Mike Tilkin, CIO of the American College of Radiology (ACR). “Radiologists will play pivotal roles throughout the care process—from the time a study is ordered to being engaged as a consultant throughout the care cycle to being a resource to the patient.”

In 2004, as Hurricane Charley closed in on Florida, the CIO of Walmart, Linda Dillman, wondered which items the store should be stocking up on in advance of the storm. Employees suggested flashlights and batteries. Dillman had another idea: diving into terabytes of data on past shopping behaviors, she discovered that ahead of hurricanes, the two most-purchased items at Walmart stores were beer and strawberry Pop-Tarts. Walmart stores in Florida increased their inventories of these items, and by the time the hurricane passed over, the company had made a killing.

As accountable-care organizations (ACOs) take root around the country, radiology, as predicted by many, is proving to be a troublesome link in the care chain. Jordan Halter, vice president of solutions for Virtual Radiologic (vRad), says, “Radiology risks being seen as a cost center, to be managed, in the ACO model. Radiology must fundamentally and permanently alter itself to survive in the new fee-for-value health-care world. It’s no longer good enough to be available and affable; groups need to be accountable, affordable, and aligned with their hospitals, as Alan Matsumoto, MD, and the ACR® Council Steering Committee pointed out earlier this year. Radiology needs to be seen as a strategic partner with a seat at the leadership table, not as a cost center.”

On June 6, 2013, at the annual meeting of the Society for Imaging Informatics in Medicine (in Dallas, Texas), Eliot Siegel, MD, chief of radiology and nuclear imaging at VA Maryland Health Care System (Baltimore), copresented “Personalized Medicine.” He envisions a promising future for radiology—if the profession can surmount the obstacles that it faces, when it comes to big data. “Medicine in general is behind the curve on big data,” Siegel says, “and we have the chance to get radiology ready for the coming era of big data and personalized medicine, if we can address five key challenges.”

In the most recent issue of this publication, I spoke of an emerging business model for radiology practices that want to maintain their independence while making the best use of economies of scale: local and/or regional affiliation. As hospitals and health systems continue to consolidate under emerging payment and delivery models, medical groups that hope to continue serving these customers as independent entities will have to increase in scope and scale to survive.

I have recently been writing commentaries in our various publications about the evolution of the practice model for the radiology group, especially as it relates to what radiologists need to do in order to succeed in a maturing marketplace. It is clear that a new normal exists in which revenue predictability and certainty about practices’ growth trajectories have been replaced by confusion, uncertainty, and discussions about reinvention. There are a couple of reasons that the need for a new strategy has now accelerated. I believe that these new market forces will be unforgiving to those who act as though this is simply another in a continuing series of minor setbacks and annoying speed bumps.

In recent years, the leadership of Advanced Diagnostic Imaging (ADI) noticed that its market of Nashville, Tennessee, was experiencing an increasingly common trend. Chad Calendine, MD, president of ADI and CMO of Optimal Radiology Partners (ORP), says, “The national partnership we formed last year with ORP validated our observations that in many markets, health systems have begun—in earnest—to employ their referral base. As health systems employ those physicians, you can be in jeopardy of having your referral base hired away. It’s a well-known vulnerability for radiology practices and imaging-center owners, but options for addressing the problem can be limited.”

The ongoing success of the imaging-center industry has resulted in the proliferation of operating and management companies; this, in turn, has resulted in the increased acquisition of controlling interests in the imaging centers by the operators. By gaining a controlling interest, the operating company is able to bring substantial experience and negotiating clout to the venture, typically enhancing value. The success of these partnerships, combined with this increased demand, has resulted in the willingness of these operating and management companies not only to acquire controlling interests in imaging centers, but to do so at a premium.