Introduction As we set out to write the trends for 2023, we see that operational efficiency is now the central theme for hospital and healthcare systems leaders. The trends we covered in our 2022 paper continue to get stronger. These included the dawn of the digital health era, the rise of telehealth, the shift to work-from- home models, surprise billing regulations, AI-enabled processing, rogue nation-states leading to increasing cybersecurity risks, and patients now responsible for arising portion of payments. A question of "the more things change, the more they remain the same?" – perhaps not, we say. 2023 is likely to be a very different and fast-paced year and mark a definitive shift in how health care is delivered and paid.

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