The entire Albany healthcare power structure is shifting, making way for new competition through collaboration, integration, and payment reform initiatives among health systems, physicians and insurers. A series of hospital acquisitions in recent years is the foundation of the new Albany Med Health System, but the recently announced merger between longtime collaborators St. Peter Health Partners and Ellis Medicine will tip the power scale to the No. 2 health system. The market only clinically integrated network joined a statewide CIN which could bring new contracting opportunities and enhanced care options to the region. Independent physician groups are collaborating on a surgery center and a facility to house multiple independent physician groups to pool resources. Powerful Pennsylvania insurer Highmark Inc. is acquiring the local Blue Cross Blue Shield plan which could shake up competition among insurers.