Healthcare consolidation continues at a brisk pace in the highly competitive New York City market, but the focus is shifting to integrating health systems into integrated delivery networks that are engaged in—or are preparing to engage in—risk-based, value-based initiatives and care coordination programs. Strategic mergers, acquisitions, and affiliations to enhance clinical integration and to strengthen negotiating power, and the move to value-based reimbursement models are the primary trends. Northwell Health, the market’s largest, most aggressively expanding health system, is investing heavily in renovations and physician acquisitions to expand its already massive network. Anticipate shifts in patient flow to continue with the increased number of urgent-care centers and new ambulatory care centers. Both affiliated and independent physicians are an integral part of healthcare transformation through their clinical expertise and success in payment reform. Insurers must still contend with high costs and tight regulations, but are answering with creative ways to retain employers, including narrow networks and incentives.