The resulting integration of health care across clinicians and participation in alternative payment models APMs , which aim to improve quality while constraining spending, are cited as reasons for consolidation, but little is known about the association between integration and APM participation. ...MAIN OUTCOMES AND MEASURES: Participation in APMs: 1 bundled payments, 2 comprehensive primary care and medical home programs, 3 pay for performance programs, 4 capitated contracts with commercial health plans, and 5 accountable care organization contracts. ...