Oak Street Health opened its first primary care center for seniors in underserved communities in 2013. By 2022 the company had 169 centers and a market valuation exceeding $10 billion. Oak Street created value by accepting risk-adjusted, capitated payments for Medicare enrollees and reducing the expected spending for these enrollees through high-quality, high-touch primary care. In 2023 CVS Health acquired Oak Street on the thesis of substantial synergies across its various businesses. Which among these synergies was most important to prioritize, and what tradeoffs might be created by pursuing these opportunities?

In July 2017, CEO Kevin Tabb of Boston's Beth Israel Deaconess Medical Center announced his plan to consolidate 11 Massachusetts hospitals under a common management structure. These hospitals collectively generated $5 billion in patient revenue and 25% of privately-insured hospital stays in the state. The merger would create a credible competitor to Partners Healthcare, the state's dominant health care provider, but would potentially reduce competition and raise prices. State regulators were assessing the merger, and Tabb needed to argue its merits.

The U.S. health care system is inefficient, unreliable, and crushingly expensive. There is no shortage of proposed solutions, but central to the best of them is the idea that health care needs more competition. In other sectors, competition improves quality and efficiency, spurs innovation, and drives down costs. Health care should be no exception. Yet providers and payers continue to try to stymie competition. Many are actively pursuing consolidation, buying up market share and increasing their bargaining power. In this article, the authors argue that health care payers and providers must stop fighting the emergence of a competitive health care marketplace and make competing on value central to their strategy. All stakeholders in the health care industry--regulators, providers, insurers, employers, and patients themselves--have roles to play in creating real competition and positive change. In particular, five catalysts will accelerate progress: Put patients at the center of care, create choice, stop rewarding volume, standardize value-based methods of payment, and make data on outcomes transparent.