The development of integrated health care systems holds many pitfalls as well as potentials. This case study describes the development of the strategy that has moved the structure, mission, and vision of a health care system. It examines the questions of what members, payers, and providers' needs are when defined around the paradigm of responsibility for the health as well as the health care of a population. It starts by examining the background of the development of the strategies used by the health system during the past decade, and the environmental climate that has led to a redefinition of the mission and vision of the organization. This movement has moved the focus on acute health services to the development of a regional integrated health care system based on collaboration and on a responsibility to improve the health of those we serve through treatment, prevention, and education. Finally, the chapter reviews the options facing all of us: do we compete, collaborate, or both?