Ochsner Health System remains the dominant system in New Orleans and continues its path to vertical integration with a direct contract with Walmart and participation in generic drug manufacturer CivicaRx. But second-largest system LCMC Health is growing and wants to compete with Ochsner as its own narrow network. BlueCross Blue Shield of Louisiana remains the top insurer, and has close ties with Ochsner through the Blue Connect plan, which has a narrow network. Managed care organizations that win Medicaid contracts for 2020 will be subject to more regulations, especially around drug prices. Health systems utilize clinically integrated networks that will make the physician sector more consolidated. Value-based contract formation is on the rise, and may break into the managed Medicaid space in 2020.