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Health systems in the market are continuing to expand, with Community Health Systems-owned Commonwealth Health committing millions to construction and expansion projects, while powerful payer/provider integrated delivery network Geisinger Health System pursues affiliations and acquisitions outside the Scranton market along with new expansions. Leading insurer Highmark’s announcement of a joint venture with rival Geisinger in four counties just northwest of the market could have ramifications in Scranton if the relationship expands. This unlikely marriage could be in response to Pittsburgh-based UPMC’s rapid expansion across the state, with Highmark and Geisinger forming a closer relationship to stave off an eventual UPMC intrusion. Regardless, the joint venture should create a more amicable relationship between Highmark and Geisinger, resulting in greater care coordination and a shift of reimbursement toward value.