King County’s major medical centers continue jockeying for position in the emerging new health-care world.

U.W. Medicine and Valley Medical Center proposed this week what they call a “strategic alliance.” Valley wants to retain its name, although the news release says Valley would become “part of U.W. Medicine.”

Earlier this year, U.W. Medicine took over running Northwest Hospital (in north Seattle), without actually owning the hospital.

As Dean Radford writes in the Renton Reporter:

Public Hospital District No. 1, which owns [Valley] medical center and neighborhood clinics, would still exist. Its five commissioners would sit on a larger board that would oversee management of Valley Medical. The Valley board would continue to oversee the hospital district itself.

In essence Valley Medical Center would become part of the UW Medicine system, which owns and operates Harborview Medical Center and the University of Washington Medical Center. UW Medicine also shares ownership and governance of Seattle Cancer Care Alliance, Children’s Hospital and Medical Center and Fred Hutchinson Cancer Research Center.

The bigger picture: U.W. Medicine and Swedish Medical Center are competing to be top-dog in the greater Seattle area. All the other hospitals are nervously watching, trying to decide if they can survive independently, or if they need to affiliate. I alluded to this in an article last spring, as the same pressures are reflected in the mad scramble to build new Emergency Departments all over King County.

The trend should be well-known to anyone in Pierce County, too, as the two major medical centers, Multicare and Franciscan, have been buying and opening outlying hospitals.

Under the new federal health law, the Affordable Care Act, hospitals are expecting they’ll need to have large networks of primary care physicians, along with specialists.

The law envisions a future payment system in medicine that penalizes hospitals whose patients do poorly after discharge. And, payments may become more similar to HMO’s (health maintenance organizations), such as Group Health Cooperative. Payments would be for achieving an outcome, keeping someone healthy, as opposed to paying every procedure and test individually.

Even if the Affordable Care Act is amended, as many in Congress now propose, the trend toward a new payment system has been embraced by many large businesses. They’re the ones who pay the bills for much of health care (along with the federal government, through Medicare).