Motivated buyer. Highmark-West Penn deal illustrates the high stakes in integration game.

The deal that brings together troubled West Penn Allegheny Health System and Highmark could cause big waves in Western Pennsylvania. "We can go to the physicians and go to the hospitals and say, 'We're going to start reimbursing based on quality metrics, outcomes, and also based on cost effectiveness.' All of a sudden, that incentive of being volume-driven completely goes away," says Dr. Tony Farah, left, of West Penn Allegheny.