Macro drivers including efforts to lower the total cost of care and increasing engagement through patient-centered care and convenient access continue to buoy investment in ambulatory care delivery by both financial and strategic investors. Additionally, payors are beginning to institute more draconian prior authorization requirements for a broader array of hospital-based procedures in an effort to shift volume to the outpatient setting. M&A activity in ambulatory surgical centers (ASCs) remains brisk while financial buyers continue to face physician alignment challenges limiting acquisition activity of high-cost specialty provider groups. Certain sectors, such as radiology and orthopedics, have seen increased activity by health systems, once seen primarily as competitors, as the more progressive systems seek partnerships with best-of-bread platforms to develop ambulatory strategies.