The San Francisco market features a mostly unconsolidated health system sector. This somewhat masks the power of Kaiser Permanente and Sutter Health, however. Kaiser Permanente includes the market’s largest health plan and a staff-model physician group. Sutter Health recently launched its own insurance operations and is working to consolidate affiliated physicians into foundations, but its strategy is threatened by lawsuits and government investigations into its contracting and pricing practices. Most of the smaller systems, with the notable exception of high-end Stanford Medicine, have banded together in the Canopy Health clinically integrated network to counter the scale of Kaiser Permanente and Sutter. Despite health systems' integration strategies, physicians remain powerful, especially in serving HMO members. National players are most influential in the health plans sector.

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