Alex Azar Azar has called recent experiments to bring down costs "lackluster" and declared his intention to "fundamentally reorient how Medicare and Medicaid pay for care."

On March 5, the Trump administration's top health official told a conference of hospital executives to hurry up. Washington has spent more than a decade slowly nudging the medical industry away from treating health care as a volume commodity business, where more care is better, and toward incentives that reward improving patients' health. In all that time, almost nothing has changed. "That transition needs to accelerate dramatically," said Alex Azar, a former Eli Lilly and Co. executive who was confirmed as secretary of Health and Human Services in January.

Azar reprised the speech three days later at a conference of health insurers, putting both hospitals and health plans on notice that his agency is "unafraid of disrupting existing arrangements simply because they're backed by powerful special interests." It's a sharp break from his predecessor, Tom Price, a former congressman and orthopedic surgeon who last year undid some of the Obama administration's plans to contain health-care costs. Price resigned in September after a scandal over his use of a private jet.

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