In 2017, four of the Nation’s largest health systems signaled intentions to come together to create two new healthcare provider organizations that would each rank in the Fortune 500. At the other end of the spectrum, numerous smaller, community hospitals faced with continued financial pressures and no apparent relief in sight, have elected to join larger systems, concluding that the benefits of scale outweigh the desire to maintain local institutional control.  And in an environment increasingly focused on the cost of care, health systems appear to have determined that acquisitions provide the most expeditious route to revenue growth and cost reduction. See the transactions here.