A fascinating business dynamic will unfold as health care providers in the United States shift from a reimbursement system that has historically paid for procedures performed to one that rewards population health — providing the total care of a community at a fixed cost and improving its members overall health. This means that to a significant degree historic areas of revenue generation will become generators of losses. While it’s common in most for-profit and nonprofit businesses for centers of revenue generation to fluctuate in their productivity, a shift of this scale represents a sea change for the health care sector that it must face head-on. The concept is especially applicable to high-cost patients, sometimes referred to as “hotspotters.” In the United States, the top 1% of high-cost patients consumes a disproportionate 28% of total health care costs, and the top 5% of high-cost patients consumes more than 50%.