The next step for central Florida’s two integrated delivery networks is to vertically integrate health plans and grow their clinically integrated networks. The market’s dominant health plans have counter strategies to increase control over consumer and employer choice by constructing payer-driven clinics and tightly aligning with physicians. Direct employer contracting is now the primary way health systems drive payment innovation as accountable care organization activity, once vibrant, has dropped off. The market’s largest independent physician group, Integrated Independent Physician Network, is primed to offer direct contracting alongside HCA North Florida. HCA North Florida directly contracting with an employer would be a major break from the health system’s traditional fee-for-service strategy and may demonstrate the indomitable influence of its local nonprofit IDN rivals.

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