During 1992-1994, a frenzy of mergers, acquisitions, and alliances took place in the health care industry. While many different organizations fell under common ownership, few initially became integrated systems. The same problems and barriers that existed prior to the mergers were incorporated into the new organization structures. But a few of the organizations formed alliances with an objective to create a truly integrated health care system. These organizations first developed a statement of their common purpose. Then they set out to optimize the interactions between the various parts of the system by predicting demand for services, standardizing leverage points, smoothing the work flow between parts, and integrating the customer into the system.