Nearly 40 top executives gathered in November 2013 at the Boca Beach Club in Boca Raton, FL, for the second annual HealthLeaders Media CEO Exchange. Attendees came from a broad range of healthcare organizations, including large health systems, community and rural hospitals, physician organizations, and payers. In small-group discussions moderated by HealthLeaders editors, these top executives debated three big-picture topics: evolving cost-reduction strategies, the risky new payer universe, and leading through the big clinical shift.