Riverside is different from other innovative markets in that population health is not easy to manage. People in the Inland Empire tend to have more chronic health issues compared to other parts of California, including homelessness, diabetes, smoking, and obesity. This is compounded by the physician shortage that has plagued the market for years, creating access issues that have left the demand for primary care unmet. Kaiser Permanente is one of the top payers, as well as the dominant health system. In addition, the IDN has a successful physician affiliation strategy that keeps physicians closely aligned with the system, though reports to the state still note there are access issues. The hospital sector is unconsolidated and competes for physician affiliations, and the variety of potential hospital partners for physicians to align with give physicians lots of bargaining power with hospitals. Physicians may want to align with health systems and payers that can manage the clinical and social dimension of a person's health. Social determinants of health could take root in the Inland Empire, boost quality outcomes, and help providers manage risk.