UPMC and Highmark’s Allegheny Health Network, the dominant healthcare players in Pittsburgh, will likely continue predetermined growth strategies in 2020 and beyond, focusing on finishing facilities and enhancing their cancer and cardiac services lines while they augment clinical integration tools with their payer arms. With the negotiations over their networks behind them, UPMC and Highmark compete by improving services and investing in research and innovation. Pittsburgh’s smaller integrated delivery networks also compete in their niche geographic areas, with Excela Health and Heritage Valley Health System partnering with each other and smaller hospitals to maintain relevance with services and geographic convenience. Pittsburgh also is the country’s prime proving ground for outcomes-based contracts with drug companies, led by innovative contracts negotiated by UPMC. Expect more consolidation in 2021, as smaller hospitals may merge with either UPMC or Allegheny Health Network due to COVID-19 financial challenges.