By Justine Griffin for the Tampa Bay Times 

The health care business in Florida and across the nation is the midst of monumental change as insurers, hospital chains and even retailers begin to venture outside their traditional roles.

Hospitals are getting into the insurance end of the business. Insurers, along with drug stores, are delivering front-line health care.

And consumers, confronted with blurring lines and a host of new options, may need a scorecard to keep up. The shifting ground continues to change where and how they go to the doctor.

BayCare, which operates 15 hospitals in Tampa Bay and the surrounding area, next month will become the second health system in the state to sell Medicare Advantage plans, the privately offered insurance policies through which many people receive their Medicare benefits.

Two other chains, Florida Hospital and Orlando Health, are providing HMO insurance plans to thousands of Disney employees this year, with hopes of expanding the model to include other employers.

Meanwhile insurance companies, from Florida Blue to UnitedHealth, are gobbling up physicians practices and creating large networks of doctors offices that offer clinical services under new company banners.

And retailers like CVS and Walgreens continue to push more toward the front lines of health care, offering online doctors’ visits and an expanding list of other medical services.

It all adds up to an industry in the middle of a shake out, executives and experts say, with players on all edges trying to stay relevant by expanding what they do.

“This is a trend that’s been emerging over the last five years,” said Peter Young, a hospital consultant. “It’s increasing each year as providers discover that they need to move up the food chain.”

Driving many of the changes is the Affordable Care Act, which helped usher in a shift in thinking about the cost of health care. Hospitals are penalized more often by insurance companies and the government when patients have more frequent stays. The focus now, Young said, is keeping patients out of the emergency room.

“What we’re seeing is that ER visits are flattening or declining all over America as health systems begin to focus on prevention,” he said. “They are redirecting non-emergent people to urgent care, and urgent care is perfect for that. That’s also why you see CVS and Walgreens getting into and expanding their clinic business.”

Read more here.