Trends show that health care spends are approximately 18 percent of gross domestic product (GDP). The prediction is that by 2022, this figure will be in the range of 19.9 percent of total GDP. Most of this spending will be due to Medicaid enrollments as propagated by ACA, tech spending, an aging population etc. As the spends increase, competitive players will all be vying to get a piece of the pie and smaller and less profitable players will be ultimately forced to sell out. A survey reveals that 88% of health care executives are in pursuit of some M & A activity. In this article we bring you answers to a few burning questions: Are hospital consolidation transactions prevalent today? What is different about the M & A transactions today when compared to those of the healthcare reform era? How have transactions been regulated to ensure and maintain appropriate market competition and avoid antitrust violations? How can health care providers best position themselves in the M&A landscape? If alignment with another hospital/system is on the horizon, what process are organizations using to navigate the transaction successfully? These and several other questions including those about potential exits will find answers in this article. This article would help healthcare executives to be proactive and determine an appropriate strategy to increase chances of success in an era of consolidation.