Sound strategic planning, even in the midst of unprecedented uncertainty and turmoil, is a critical element of every successful health care organization's action plan. The author examines how one organization has responded to the changing demands of the marketplace and a dramatically changed reimbursement system through appropriate strategic planning, selective downsizing on certain fronts and new product development expansion on others. The result is an organization molded to the new environment. It is no longer based on an illness-model hospital but rather focuses on a vertically integrated multi-health cluster intent on capturing market share by providing a single source continuum of health care.