Hospitals and their medical staffs have become progressively more integrated and that trend will continue, particularly as the number of physicians as asking the hospital to formally incorporate their practice. Provider groups that want to be at the forefront of their markets may want to consider taking the next step of directly contracting with local employers and self-pay patients by becoming a regional health insurer.  This would eliminate the traditional insurance companies and HMOs but would entail a degree of clinical and administrative integration not heretofore common in many medical delivery systems. through the federal program call the Consumer Operated and Oriented Plans (CO-OP). The Patient Protection and Affordable Care Act (the “Act”) has created this new program and proposes to fund the startup costs as well as provide the necessary financial reserves. To back up these non-profit, federally tax-exempt health insurance companies, the federal government has pledged $6 billion that will distributed to qualified organizations between now and July1, 2013. Verras’ technologies, physician-directed, best practice improvement and consulting services are the means by which a provider organization can meet the operational, clinical quality and cost efficiency mandates of CO-OPs.