Washington, D.C. remains unconsolidated and highly competitive. The market’s health systems weathered the COVID-19 pandemic and are looking to grow. In northern Virginia, Inova Health System is expanding acute and outpatient services to stay ahead of local rivals—primarily Mary Washington Healthcare and Virginia Hospital Center. East of the Potomac, MedStar Health and Adventist HealthCare are expanding and replacing hospitals and building new outpatient centers to compete with each other and the numerous smaller systems in the region. As these systems grow, they will likely integrate their physician practices to better coordinate care, putting more pressure on the market’s plethora of independent physicians to align via employment or affiliation. Small practices facing financial shortfalls after the COVID-19 pandemic may be amenable to alignment. However, large independent organizations, such as Privia Health, provide an alternative for physicians who do not wish to sacrifice their autonomy. Moderate consolidation around the largest insurance carriers in the market, especially CareFirst BlueCross BlueShield, gives these plans more leverage in negotiations with providers and more influence over care delivery. CareFirst is especially poised for further growth. The carrier has dominant commercial enrollment, a partnership with the state of Maryland’s Medicare waiver—a driver of much of the payment reform in Washington, D.C., and a new ACO with MedStar Health.