After a period of rapid deal-making and legislative/regulatory upheaval transformed relationships between providers and payers, the Minneapolis healthcare market appeared to be settling into a new paradigm. Amid the COVID-19 pandemic, however, disruption reigns again. Pandemic financial challenges highlight the benefits of hospitals owning their own health plans and should be expected to accelerate vertical integration efforts already underway at the market’s leading health systems. Losses suffered during the pandemic by North Memorial Health —the market’s largest health system without an owned health plan—likely put a merger back in play shortly after the system appeared to have sidestepped consolidation pressure by launching a joint venture with Blue Cross and Blue Shield of Minnesota. Fairview tripled its telehealth caseload from 2019—in a single month (March 2020) —and now plans to close more than a dozen clinics, partly in response to increased demand for virtual care. As tech disruptors (including platform players in the virtual space) gain traction, and health systems struggle through the pandemic, expect payers to wield more leverage in pricing negotiations. And with many employers contending with their own pandemic challenges, expect increases in the prevalence of narrow networks and the degree to which patients are referred away from expensive, hospital-based providers and toward community-based physician groups.