A number of years ago a taxonomy of health networks and systems was created, using data from the mid-1990s, for the purpose of defining the structures and strategies of newly emerging health care organizations and identifying classes of health care organizations that share common features (Bazzoli et al. 1999). Since that time, the taxonomy has become a valuable tool not only for policymakers and practitioners, but also for health services researchers who have used it to address the performance of groups of health organizations that share similar characteristics (Bazzoli et al. 2000; Bazzoli et al. 2001; Carey 2003; Dubbs 2003; Lee Alexander and Bazzoli 2003; Rosko and Proenca 2003; Shortell, Bazzoli et al. 2000). The health care world, however, has changed a great deal since the mid-1990s and in order for a taxonomy of health networks and systems to continue to be useful, it must be periodically updated to assure it appropriately depicts the spectrum of current organizational configurations. When the initial taxonomy of health networks and systems was created, it reflected organizations' anticipation of continued strong momentum toward service and financial integration created by the prospects for national health care reform in 1994. By 1998, however, this momentum had slowed substantially. In addition, by the late 1990s, capitation trends had failed to unfold as anticipated, consumer backlash against managed care had intensified, merger activity had decreased, and vertical disintegration had begun to occur (Bazzoli et al. 2001; Lesser and Ginsburg 2000; Shortell, Gillies et al. 2000b). As organizational configurations shifted and members of health networks/systems realigned, the major categories of organizations identified in the taxonomy may have changed. As a first step toward understanding these changes, a longitudinal study of organizational trends from 1994 to 1998 was conducted using the original taxonomy categorization scheme (Bazzoli et al. 2001). In this work, significant shifts were found in the numbers of observations appearing in each organizational category, as well as a general shift whereby observations tended to go from the centralized categories to the more moderately centralized categories. Now, as a next step, the work described in this paper explores the possibility that, over time, there could be additional changes in organizational structure whereby 1998 networks/systems actually cluster into entirely new categories than they did five years ago. The objectives of this paper are to revisit the taxonomy of health networks and systems in order to: (a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; (b) identify any new patterns of cluster configurations; and (c) demonstrate how additional data can be used to refine and enhance the taxonomy measures.