Watch the Sacramento healthcare market because it is a perfect Petri dish for new contracting and payment arrangements, says health economist Paul Ginsburg. With four powerful nonprofit health systems—each aligned with physician groups—Sacramento is the most organized market in the state. The strong presence of HMOs, growing dominance of Kaiser Permanente and influence of the California Public Employees' Retirement System makes Sacramento a good place for innovative approaches like narrow networks and global payments that require health plans, hospitals and doctors to work together, Ginsburg said recently at a Sacramento forum.