To combat declining reimbursement and strengthen their positions in a highly competitive provider environment, leaders of large medical groups may consider forming an integrate delivery system (IDS) to gain a business advantage. Managing the array of organizational, operational, financial and human relationships affected by an IDS requires careful planning, good timing and a bit of luck. This article, the first of a two-part series, examines what questions physician practice leaders should ask--and answer--before formiing an IDS.

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