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The Affordable Care Act has energized five fundamental shifts in health care over the past five years, according to a new  by the PwC Health Research Institute. They are a shift in risk away from traditional insurers and onto providers and others; a renewed emphasis on primary care; an influx of companies to a new health economy focused on innovation; a shift from wholesale to retail health insurance; and an increased role for states in shaping the health care landscape. “Despite the challenges, these key trends – accentuated and accelerated by the law – continue to push forward, building opportunities and risks within the New Health Economy,” the authors said.