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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.

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