Consolidation continues to drive the Providence market, accelerated by the COVID-10 pandemic, which is challenging health systems and physician groups financially. Market leader Lifespan and in-state rival Care New England have signed a letter of intent to merge through a deal that would establish a single, nonprofit academic medical center with Brown University, significantly altering the state’s healthcare landscape. As health systems and physician groups pursue strategies to mitigate the financial impact of the pandemic, payers are realizing staggering profits because sharp declines in expensive, elective procedures have reduced healthcare expenditures. In turn, payers are providing premium credits and waiving cost-sharing for COVID-19 related testing and treatment. When the market begins to recover, expect health systems, physician groups, and insurers to use their experience to develop new delivery systems through telemedicine, innovation, and payment reform.