Health systems must take the lead in managing the financial risk of care delivery – not wait for government – was a key message from Scottsdale Institute’s 2018 Annual Conference “Pushing Past the Payment Barrier: From Innovation to Transformation of Healthcare” in Scottsdale, Arizona. To achieve that goal they need to build scale, integrate vertically and horizontally and deliver value to consumers according to the lively discussions, presentations and audience interaction at the Camelback Inn.