Though Norfolk has been a highly consolidated and siloed market, there are signs of progress, with new partnerships and care coordination announcements in recent years. Local integrated delivery network Sentara Healthcare and its insurance arm, Optima Health Plan, are influential entities that drive many developments in the market. Bon Secours has a new parent company, Mercy Health, and the company made a significant hospital purchase in late 2019 to remain competitive with Sentara and Riverside Health System. Optima Health is now a participant in the Medicare Advantage Value-Based Insurance Design model. The majority of value-based care in the area revolves around the Medicare program and bundled payment activity, with little commercial care coordination. There is a dearth of providers in the market, particularly oncologists. The lack of cancer specialists will be tested by Sentara’s new cancer center at Leigh Hospital. Elsewhere, legislation has led to significant changes in the market. Gov. Ralph Northam signed legislation to expand Medicaid and to mandate reimbursement of remote monitoring telemedicine services.