This white paper analyzes the interplay of those middle market health care business mergers and acquisitions with the four-part, patient-care-centric conceptual framework of ownership, organization, payment and delivery that we described in our October 2018 white paper entitled, “Health Care ‘Prime’ – The Shaping of Health Care in America Through M+A and Innovation.”2 That writing sought to explain, through the four-part framework, how six identified themes and outcomes are being implemented through mergers and acquisitions and innovation activities as significant change agents in remaking the future of health care.3 In that original white paper, we used mega-deals to illustrate the remaking. We labeled the cumulative activity during this period of accelerating change as “Health Care ‘Prime’” and concluded that this era will be centered on the patient more than in the past.