To slow the growth of health care spending and improve coordination and quality of care, providers and payers are working together to change how care is delivered and paid for.

Los Angeles is a large, densely populated, racially and ethnically diverse county with wide income variation, traits that contribute to a fragmented health care market.

San Diego hospitals remain stable, but face increasing cost pressures from payers emphasizing provider affordability and value.

Orange County has largely recovered from the economic downturn, yet socioeconomic variation persists, and Medi-Cal coverage has spiked.