First published by Tom Bergeron on NJBiz.com.

The idea did have some merit. Based on the consolidation in the industry, one of our insiders surmised, shouldn’t the NJBIZ Power 50 Health Care list be reduced, too?

“Really, you should make it the Power 25,” the insider suggested.

Doing so, however, might overlook and obscure one of the biggest movements in health care in New Jersey: the encroachment of outsiders.

It’s a truly ironic twist. A state that for so long has fought to prove to outsiders that it stands on its merit is now being invaded by those outsiders, wanting to get a piece of the action.

MD Anderson and now Memorial Sloan Kettering are finding partners and patients in the Garden State. Patients they are eager to treat here, not to send to New York City and Philadelphia.

Telemedicine, which has no home base, is expanding — and seemingly will take an exponential jump in coming years, if not this one. As is elder care.

And, as the experts at our health care panel last winter noted, more outside money from venture capital groups is finding its way inside our borders, too.

One insider said this is simply the way of the future — pointing to the MSK partnership with Hackensack Meridian Health.

“If you told the heads of MSK three years ago that they would be partners with Hackensack Meridian, they would have fallen out of their chairs laughing,” the insider said. “Now, they are fighting for it.”

The reasons, the insider said, are simple. And financial.

“It sounds crazy, but people finally seemed to have realized that so many people who work in New York City actually live in New Jersey,” the insider said. “So instead of fighting to serve them in New York, they realize it’s more convenient to serve them in New Jersey. And cheaper.

“They can set up in New York City and pay $75 a square foot, or set up in New Jersey at $35.”

Chasing dollars is more important than ever.

And if you want to remain a power player in the state — gain inclusion on this list or rate high on any other type of metric — you cannot simply rest on your laurels. Or, better put, your size or stature in the market.

It’s the reason Hackensack Meridian and RWJBarnabas Health have so many representatives on their list.

It’s easy to say their inclusion is based on their size. But it’s smarter to say both organizations are run by forward-thinking teams of people who know just being a big system is no longer enough.

They are partnering with others. And in some cases, those partners come from out of state.

It’s the way of the future.

“Too many people are chasing too few dollars,” the insider said. “You need to have partners to survive. And some people are slow to realize that. They are becoming low-hanging fruit for others.

“The days of walls and kingdoms are over.”

Fail to adjust at your own peril.