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Affiliations are a driving force behind recent shifts in the Albany market. Market leader Albany Medical Center’s affiliation with Saratoga Hospital could prompt action from its competitors. While a partnership seemed plausible between the area’s two other major health systems, Ellis Medicine’s decision to remain independent has made their next move uncertain. More decisive shifts in strategic plans are currently difficult to predict among the area’s health systems but expect safe investments to be made in integration, services, and each health system’s respective physician groups. The two largest independent physician groups merged, giving the combined group greater influence and negotiating power.