After a busy M&A month in February, with 125 deals reported, March didn’t disappoint. Preliminary results show deal volume equaled the previous month’s total. The figures look good, in the face of the recent stock market swings, the Trump administration’s talk of trade wars and cancelling trade deals.

But a look back to March 2017 shows this month’s deal volume is down 19% compared with the 155 deals logged then. And that wase in the face of the Trump administration’s efforts to repeal and replace the Affordable Care Act. Check out the April issue of Health Care M&A News for the deal volume and value charts, by sector.

We’re not saying this year’s healthcare market is lacking in drama. Far from it. A look at March 2018’s spending total puts that thought to rest. Thanks to a single mega-deal, which contributed $67 billion, the monthly total hit $71.4 billion, up 664% compared with February’s $9.3 billion and up 1265% compared with March 2017’s mere $5.2 billion.

The big deal was Cigna’s (NYSE: CI) acquisition of Express Scripts Holdings (NYSE: ESRX), which gives the insurer its own pharmacy benefits manager (PBM). Express Scripts was the last major PBM on the market, after a flurry of consolidation hit the market in 2015 and UnitedHealth Group’s Optum (NYSE: UNH) acquired Catamaran Corp. for $12.8 billion.

But that wasn’t a “disruptor” deal, by any measure. Ever since CVS Health (NYSE: CVS) and Aetna (NYSE: AET) announced their hook-up last December, that term has been bandied about on all sides of the industry, from healthcare providers and payers to analysts and investors. That was real disruption.

So was the merger talks between Ascension, the largest Catholic not-for-profit health system in the country, and Providence St. Joseph, a smaller health system on the West Coast and Pacific Northwest. The talks were made public in December, too. The merger would have created the largest hospital system in the country, surpassing HCA Healthcare (NYSE: HCA), which operates 172 hospitals, with more than 200 hospitals across the country.

In late March, the parties halted their merger talks, at least for now. Ascension’s management instead has adopted a new strategic direction that will rebalance its hospital portfolio in favor of more outpatient services and telemedicine, and to invest in its ancillary businesses, such as revenue cycle management. It is also forming a generic drug company with Intermountain Healthcare, SSM Health and Trinity Health, to combat skyrocketing drug costs as payors scale back reimbursement.

Now that’s disruption—realizing that “bigger is better” isn’t a universal truth, and committing to change. Every hospital and health system is faced with the same challenges of falling inpatient volumes and reimbursement levels, among many others.

The impetus today is still towards smaller hospital systems merging with similar systems to create regional systems that boast of economies of scale and stronger negotiating leverage. But when they can’t fill the beds in their new patient towers, they’ll be disrupted, too.