In St. Louis, health systems drive risk-based payment models, construct new facilities and convenient care locations, and offer telehealth. These factors make health systems the most influential sector in the market. The physician sector is unconsolidated, and several of the largest groups leverage health system connections to manage population health and participate in value-based contracting. Individuals in the market find it easier to access care than in other parts of the country because St. Louis has a higher rate of primary care providers and specialists than the national average. Expect the physician sector to become more consolidated as small and independent practices respond to the financial pressures of COVID-19. Health systems’ employed physician groups could grow, which would give IDNs an edge in population health management and payer negotiations. National carriers dominate the payer space. Cigna relies on commercial lives and the health insurance exchange. Cigna’s market position may be vulnerable as more carriers enter the exchange and compete for individual plan lives. Centene may surpass Cigna through Medicaid enrollment and competitive exchange rates.