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It is early 2018, and Cigna announced its acquisition of Express Scripts, CVS Health recently announced its acquisition of Aetna, Humana its 40% ownership stake in Kindred[1], and Optum recently announced its DaVita Medical Group (formerly HealthCare Partners) acquisition. It was a mad rush to find assets or become buyer targets for each of the major healthcare corporations. These were major alignments of payer, provider, post-acute, and pharmacy-benefit management that set a precedent for future vertical integrations and alignment strategies to come. In 2022, rampant vertical integration is back but this is a much different environment.