The alignment between hospitals and physicians which is sought to produce better value –- improved outcomes at lower cost with a better patient experience of care --  takes a range of forms. These include new phenomena like accountable care organizations (ACOs), clinically integrated networks (CINs)-- a non-specific characterization of a range of provider networks-- bundled payment, gainsharing, pay for performance, and probably the most widely deployed: hospital employment of physicians.  As Alice reports, the latter has proven not only a profound failure – losing hospitals by many estimates $100,000 and more per physician, it has also now been shown to cost the Medicare program much more money on just four outpatient procedures alone.  A different model of leasing the physician practice to the health system or hospital has been little examined, analyzed or reviewed.  Alice has created a fair number of these transactions around the country, with different specialties.  She first presented a teleconference and wrote an initial article on the subject in 2012.  In 2017 she published another article, and presented a longer teleconference addressing both what makes this approach potentially better than hospital employment and the fundamental elements of the relationships.  Now, going far further,  in an in-depth presentation of a specific guide on how to structure such an arrangement in her article “Lessons Learned from Leasing: A Blueprint for Physician-Hospital Alignment", she presents the lessons she has learned from multiple transactions that have now been in effect long enough to have involved second negotiations.  These transactions can garner all the alignment the parties want allowing the physician group to retain its cohesion, while producing more value when they are founded on clinical integration principles. If they go wrong, the termination is far easier since it is merely the termination of a contract. These leasing arrangements deserve far more attention than they have received to date.