The status quo in Madison will continue now that the merger between UnityPoint Health and South Dakota-based Sanford Health has been called off. UW Health retains its market lead with the most inpatient volume and the largest employed physician group, as well as majority ownership in Madison’s second-largest insurer, Quartz. Advocate Aurora Health's purchase of a stake in Quartz signals the increasing influence it will exert on payers and providers in coming years. The modest number of independent providers remaining in the market will likewise feel more pressure to align with a major health system as these IDNs grow and consolidate to protect their market shares. The dominance of local payer/provider networks will continue to shut national carriers out of the market, and an increasing focus on value-based care could renew efforts among Madison’s health systems to form clinically integrated physician networks, which have not existed in the market since 2017.