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Payer consolidation is a fact of life for providers throughout the country. For example, some providers are adjusting to the national PacifiCare-UnitedHealthcare merger, whereas others are evaluating the effect of the proposed consolidation of Pennsylvania's two largest insurers, Pittsburgh-based Highmark and Independence Blue Cross of Philadelphia. However, collaboration between payers on jointly marketed products is a more insidious phenomenon that's also creeping into contractual agreements, especially with hospitals and healthcare systems.