Norton Healthcare, UofL Health, and Baptist Health have firmly established themselves as Louisville’s top health systems following the departure of national nonprofit CommonSpirit Health. These systems are now racing to build new care sites and expand service offerings, despite likely delays due to the COVID-19 pandemic. Given Norton’s dominant market share and recent moves to grow beyond Louisville, UofL and Baptist are likely destined to compete for second place in the market. As these systems grow, they will likely continue to prefer physician employment over affiliation, as this gives them significant control over care delivery. This growth will put more pressure on Louisville’s independent physician sector to align with a health system. These providers drive value-based contracting in the market and may present as ideal candidates for partnerships with commercial carriers seeking to counter the growing influence of health systems. That said, commercial carriers in the market have favored partnerships with health systems, which gives them access to broad provider networks noted by insiders to be preferred by area residents. Expect this dynamic to produce new value-based contracts between integrated delivery networks and commercial carriers in coming years.