Pennsylvania is one of the most intriguing healthcare states in the nation, and it may offer a glimpse of the future of American healthcare. In the western portion of the state, two vertically integrated payer/provider systems are battling for market share under the terms of a 10-year deal that creates mutually exclusive networks for Highmark Blue Cross Blue Shield and UPMC, although some UPMC facilities remain in-network for Highmark. In the southeast, Philadelphia's Independence Blue Cross is demonstrating how a dominant insurer in a large city can corral a fragmented health system market toward accountable care. National insurers (namely UnitedHealth and Aetna) continue to adjust their strategies to compete against the Keystone state-based managed care organizations.

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