Known as a market where hospital systems focus on particular niches rather than head-to-head competition, Seattle now faces growing competition as hospital systems vie for market share in the city and seek new affiliations and growth in affluent suburbs. This is the lead finding from a new Community Report released by the Center for Studying Health System Change (HSC). The Urban Institute's Ian Hill and Bob Berenson were two of three team leaders who conducted a site visit to the Seattle metropolitan area in April 2010 to interview over 50 health leaders to examine how health care is organized, financed and delivered in the community. The report was developed as part of HSC's Community Tracking Study, a project that has monitored health system evolution in 12 communities (including Seattle) since 1996, and which is jointly funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.