Value-based contracting has a foothold in Chicago through the market's numerous ACOs. While expansive business plans are on hold as integrated delivery networks develop COVID-19 treatment protocols and prepare for a possible patient surge, more consolidation is likely in the coming years. Advocate Aurora Health, the largest IDN, plans an ambitious geographic and service line expansion to weather the challenges of risk-based deals. Northwestern Medicine now accepts more risk as part of Blue Cross and Blue Shield of Illinois’ HMO network for Medicare Advantage and exchange plans. Meanwhile, Amita Health is making cuts, moving some service lines to larger hospitals while working to close redundant facilities. As the market’s Medicare ACOs step up risk-sharing, the realities of lower reimbursement force decisions about staffing, successful care coordination, and location. Chicago’s significant Medicaid population stresses already struggling safety-net facilities. Insurers have their own financial squeeze with a new state tax for 2020 and a statewide preferred drug list for Medicaid MCOs. Major IDNs are incorporating behavioral healthcare into medical visits and using artificial intelligence to predict patient outcomes, particularly with cardiac events. Expect continued IDN consolidation and more intense debates about how to develop risk-based contracts.

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