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The Seattle healthcare industry is in a period of increasing consolidation and disruption. Hospital affiliations are on the rise as local health systems compete for more power and larger footprints to better handle increased operating, clinical, and financial complexities and risks. Unfavorable shifts in payer mix and across-the-board downward pressure on reimbursements from government and commercial payers are a primary challenge. By seeking sufficient size and geographic distribution to meet the varied needs of patient populations, Seattle health systems might ensure a smoother transition from a fee-for-service to a value-based reimbursement system. Additionally, health systems are targeting core service lines and outpatient services to combat declining inpatient volumes. The outlook for branded drug sales overall is negative as the market moves toward increasingly standardized and cost-efficient care protocols, but there is an opportunity for manufacturers that can make an evidence-based pitch for their drugs, especially those willing to enter into value-based contracts themselves.