Wedged between other large markets, Wilmington is both heavy consolidated but also relatively advanced compared to many markets of similar size. The market is beginning to make strides on value-based care and a break into accepting greater risk could be close. The commercial payer segment has seen relatively slow migration into value-based care but that could change as more payers contract with top providers that show willingness to move away from fee-for-service. Highmark continues to dominate the insurance market, but its closest competitor, CVS Health–owned Aetna, commands second place by virtue of its strength in the commercial market. The Delaware legislative body has been active in healthcare, crafting laws that will tighten spending increases and move Medicaid members into accountable care.