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Cincinnati continues to be driven by developments among the market's major integrated delivery networks. These coordinated, clinically integrated systems are leading the market in its movement towards alternative payment models (including employer direct contracts, bundled payments, and accountable care organizations), and are expanding into growing neighborhoods and high-profile therapeutic areas. National health plans continue to dominate commercial and Medicare Advantage enrollment in the market, while Ohio's own CareSource leads the managed Medicaid sector. Overall, the market appears primed for additional payment innovation models and plan designs that can direct patients to a single IDN or pair of IDNs, in exchange for lower monthly premiums.