It was a weekday evening, and I had just walked into the nearly empty grocery store and grabbed a shopping cart. I paused to look at the newspaper rack, when I felt a sharp pain in my shoulder, coupled with a force that pushed me backward. I looked up and saw a woman glaring at me. A second later, she started yelling in a language I didn't recognize.

I was bothered less by being punched than by my inability to figure out why I had been punched. Yes, the woman seemed unhinged, but I still found myself, as I shopped and later in the evening, trying to form some connection between my actions and her punching me.

The feeling of disconnection is all too common in health care. Patients give the same demographic information to multiple providers within the same network. Patients and families often are responsible for coordinating care across various settings. Providers - within the same organization and in multiple organizations- struggle to coordinate their information systems, their handoffs, and their payment incentives to create an efficient system that fosters population health, not just treatment of individual episodes.

This issue othfm features several articles that show how provider organizations are creating connections among the disparate parts of our system.

"Right Care, Right Place, Right Time, Every Time" by Nancy Nowak, Holly Rimmasch, Ann Kirby, and Chad Kellogg, focuses on improving coordination within a hospital. The article shows how Intel-mountain Healthcare used lessons from one hospital to improve patient flow throughout the system.

In our executive interview, Cyndi Pittman, CFO of Baptist Memorial Health Care -Memphis, explains an initiative to improve coordination for patients transitioning from the hospital into the community. The model uses "transition coaches, who help our patients who have complex discharge plans to return to and stay in their medical home."

"Evolve and Integrate: A New Imperative for Ambulatory Care" by Tracy Johnson and Suzanne Borgos moves outside the traditional hospital walls to show the attributes of a successful outpatient delivery network, including costeffective, coordinated care.

In "The Next Wave of Hospital Consolidation," Lisa Goldstein takes a step back even further to show partnerships created to fulfill "the promise of greater operating efficiency and risk diversification across larger organizations." Goldstein reviews some of the new relationships being driven by a sluggish economy, rising healthcare costs, and downward payment pressure. Those relationships include hospitals and payers, private equity funds and not-for-profit hospitals, and for-profit and not-for-profit systems. AU these dimensions are important as health care strives to create connections that will achieve a true system.

As for me, I have low expectations for logical connections in my grocery-store encounters. But I may wear protective padding on my next shopping trip.

Author affiliation:

Robert Fromberg

Editor-in-Chief