Healthcare in Grand Rapids is highly consolidated around Spectrum Health, Mercy Health, and Metro Health, enhancing providers’ care coordination capabilities and paving the way for more innovative alternative payment models. Mercy Health and Metro Health are expanding their affiliation to counter the dominant Spectrum Health. Spectrum wields considerable influence through its leading share of inpatient volume, convenient-care locations, and ownership of the market’s second-largest health plan, Priority Health. Dominant insurer Blue Cross Blue Shield of Michigan is the market’s primary driver of value-based care and began mandating downside risk in 2021 under its Blueprint for Affordability program, which now includes most providers in the market, except for Spectrum. As arrangements like Blueprint for Affordability become more common, independent physicians will feel more pressure to align with a major health system or the market’s largest independent network, Answer Health. Providers are also beginning to explore ways to undercut the dominance of large payers like BCBS of Michigan, contracting directly with area employers to provide care. Payers will continue experimenting with narrow network designs to offer low-cost options for employers.