Pennsylvania juggernauts UPMC and Highmark have transformed Harrisburg into another front in their competition. Penn State Health, in which Highmark maintains a minority stake, is rapidly expanding, acquiring Geisinger Holy Spirit and building two new hospitals near UPMC Pinnacle sites. In response, UPMC is expanding its West Shore hospital and building new outpatient locations throughout the market. WellSpan Health is also expanding, as well as partnering with Capital BlueCross in a strategy that mirrors UPMC and Penn State. As these systems build themselves into vertically integrated networks, they are acquiring and affiliating with more physicians in the market, seeking to improve care coordination and keep more patients within their networks. This increased consolidation among providers will support new innovative payment arrangements, which have been relatively nascent in the market.