Hospitals and large physician groups merge regionally. Specialty care is capitated. Point of service plans are losing leaders for marketing by the HMOs to entice subscribers. Tertiary services are consolidated regionally. Quality is now defined by clinical pathways or best practice models and benchmark outcomes.
Integrated providers struggle to sustain reasonable capitation fees.
Further merger and integration of hospitals, physicians and HMOs into larger corporate entities. Minneapolis-St Paul, Portland, San Francisco, Los Angeles and San Diego. The durability of even large PPOs. IPOs and IPAs in the market place is over. Substantially downsizing of management and providers has occurred.