To Mary Gallagher, Any Town Hospital's new CEO, the growing need for physicians and administrators to work together to solve the challenges before them seemed obvious. Physicians agreed, but little progress had occurred. Recessionary government budgets and employer pushback through reduced benefits and increased co-payments seemed ominous. Medical malpractice premiums were spiraling upwards, pharmaceutical costs were escalating, and the percentage of health care insurance premiums going to medical claims was decreasing. The basis for competition was shifting from managed care contracting to quality, demanding further financial investments (e.g., computer technology).