A whole lotta conjunctions goin’ on with California health care system players, an exceptional surge of large acquisitions and consolidations, some with surprising pairings. Fueled by game-changing facets of the federal Patient Protection and Affordable Care Act, pursuits of cost efficiencies, purchasing and pricing power and economies of scale, quality enhancements, the determination of payor and hospital systems to align with physician groups to achieve these, employer demands for controlling coverage costs, the provider partnership needs of the rapidly emerging “Accountable Care Organizations,” “dual eligibles” programs and other PPACA constructs (add in a dash of good old-fashioned hegemonic cravings), and big new relationships in the health care delivery system are poppin’. And this follows on the recent, rapid growth of hospital-bound physician medical foundations in California in pursuit of similar objectives. The consolidation of HMOs in California, of course, occurred primarily in the past century.

The rapid move is on nationally toward greater coordination and integration of care, away from fragmented nonsystems of care; towards value-based models of reimbursement and away from volume-stimulating fee-for-service compensation. The theme is that providers should be incentivized and rewarded for keeping patients healthy and curbing costs. Some skeptics see this as dreamy HMO deja vu all over again, but this time the player mixes are more diversified and less monolithic than traditional HMO companies. And the federal government is into it in a big way, courtesy of PPACA.

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