Birmingham, a statewide hub for specialty care, has historically been a slow-moving market from the perspective of value-based contracting. BCBS of Alabama is the power player and key driver of quality in the market and offers multiple programs aimed at improving clinical outcomes and enhancing provider accountability and efficiency. There are few ACOs operating in the market, and all of them are Medicare ACOs. COVID-19 is driving new trends in Birmingham, just as it has in most of the country. There is increased probability that rural hospitals will close without the financial cushion to absorb the COVID-19 crisis, and Bibb County Medical Center is an example of a vulnerable rural hospital in this market. Telemedicine has become more prevalent during the pandemic, and increased demand for telemedicine services is expected to negatively impact volume for urgent-care clinics. UAB’s new alliance with Ascension will give the integrated delivery network increased purchasing power, making it more difficult for competing systems to advance their networks within the market, which UAB already dominates.