Medicine is being disrupted from every angle, as the financing and organization of clinical care are overhauled and scientific knowledge grows increasingly sophisticated. Academic health centers are being asked to provide a more patient-centered approach, while meeting the challenges posed by the Affordable Care Act and the evolving demands of Medicaid and Medicare. They must remain on the forefront of the innovative research that may make tools like swallowable digital cameras and artificial organs commonplace, but also manage the soaring cost of that research. CEOs from three of the nation’s leading health systems come together to talk about what’s on the horizon.