Highmark Inc. wants to save West Penn Allegheny Health System with a $475 million acquisition that it says will preserve competition for medical services in Western Pennsylvania. At the same time, the state's largest health care insurance company says its strategy includes establishing an integrated health care delivery system—including hospitals, outpatient centers, physician practices and insurance—that will promote "innovative care models and lower-cost sites of treatment." Those two goals, however, create a paradox for Highmark.