As Beaumont and Spectrum explore a merger, executives from both health systems work to stabilize costs, improve care, and attract and retain talent. But payer costs remain a critical concern for employers and private insurers across the state.

Facing the prospect of stagnant or declining revenue at home, around three dozen of America’s elite hospitals and health systems are searching with a missionary zeal for patients and insurers able to pay high prices that will preserve their financial successes.

"We knew this was going to be bad, but I don't think even those of us who work in this area thought it was going to be this bad," said Harvard health policy professor David Grabowski, a nationally recognized expert on long-term care who reviewed the GAO report.

VCU Health is forming a new joint venture with home health not-for-profit Bayada to deliver hospice and home health in the hope for better quality outcomes.