The economic reality of reform has already caused major change in the healthcare industry. The implementation of health insurance exchanges (both public and private) will materially impact the landscape for hospitals, and their responses to these changes can have significant implications for future reimbursement and operations. Provider and payor organizations in all markets of the country are undergoing extensive planning to establish thoughtful and diligent strategies to prepare for health insurance exchanges. Providers must prepare for these changes by understanding the developments in their states and strategically evaluating their options for participating in the exchange products emerging in their markets. This presentation focuses on the important considerations and critical implications of the exchange market that should be central to hospital strategic, operational, and financial planning for 2014 and beyond.