This is the 22nd edition of Michigan Health Market Review, our annual reports analyzing the health care payer and provider markets in the state. The reports provide a comprehensive and objective analysis of strategies and key trends for the health insurers and provider systems in Michigan. Part One presents our analysis of the health insurers, their financial performance, enrollment and market share. Part Two reports on the health systems, their financial results and their inpatient occupancy and payer mix. The reports also include an extended analysis of implementation of key elements of the Affordable Care Act in the state, including Medicaid expansion, Medicare Accountable Care Organizations and development in the individual market.