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The Seattle healthcare industry is in a period of increasing consolidation and disruption. Hospital affiliations are on the rise as local health systems compete for more power and larger footprints to better handle increasing operating, clinical, and financial complexities and risks. Unfavorable shifts in payer mix and across-the-board downward pressure on reimbursements from government and commercial payers are primary challenges. While health systems increasingly are employing and clinically integrating with physicians, provider-owned health plans are not prominent in the Seattle market. Instead, health systems have created large ACOs and signed narrow network contracts with commercial payers and directly with large employers. The outlook for branded drug sales is negative as the market moves toward more standardized and cost-efficient care protocols, but there is an opportunity for companies that can make an evidence-based pitch for their drugs, especially those willing to enter value-based contracts themselves.