Highly unconsolidated provider sectors and an unfavorable payer mix characterize the Los Angeles healthcare market.The poverty rate in the city of Los Angeles exceeds 20 percent, and marketwide unemployment and uninsured rates are higher than state and national averages. Illustrating the prevalence of government programs, L.A. Care Health Plan is the market’s largest insurer despite offering only Medicaid and exchange coverage. These programs also drive reform in the market. The influence of management services organizations in the physician sector continues to grow. While low, consolidation is on the rise in the Los Angeles market, as is vertical integration. Insurers drive the latter, highlighted by UnitedHealth Group’s planned 2019 acquisition of DaVita Medical Group. Expect runner-up health systems to more aggressively pursue both consolidation and vertical integration in a bid to challenge market leader Kaiser Permanente and improve negotiating leverage with payers.

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