Springfield’s largely unconsolidated payer landscape is changing with the merger of Tufts Health Plan and Harvard Pilgrim Health Care. The merger increases competition for market leaders Health New England and Blue Cross Blue Shield of Massachusetts and could lead to new products, provider partnerships, and value-based contracts as insurers fight for market share. In the provider sector, Baystate Health continues to dominate Springfield, with more than half of the market’s inpatient discharges. Trinity Health is working to become a viable alternative to Baystate by growing a clinically integrated network that links the system’s Massachusetts providers with those in Connecticut. Health systems are also undergoing brick-and-mortar expansion to discourage access-related outmigration to facilities in Boston. Baystate Health and Holyoke Medical Center are targeting behavioral health for growth, while Mercy Medical Center focuses on expanding access to cancer care. We expect these expansions to lead to increased drug utilization locally.