The ever increasing consolidation among providers has taken the form of hospital and health system mergers and affiliations and above all, of much more employment by hospitals of physicians.  As we have written and have offered in teleconferences size does not guarantee value.  In fact, one of our critical complaints about all the employment and consolidation is that these relationships are predicated on mutual delusions among the physicians and the hospitals employing them. We have been ceaselessly banging the clinical integration drum, making the point that without real process and organizational change value cannot improve.  In CISAT v 2.0, we offer a tool to help physicians in relationships within their own groups as well as with hospitals, to move from where they are today.  In CISAT v 2.1, Alice created a version that can be used by otherwise independent practices coming together in order to clinically integrate, without merger or employment. Now we have evidence that small primary care physician practices have low rates of preventable hospital admissions. In a Commonwealth Fund report, researchers found that practices with one or two physicians had 33% fewer preventable hospital admissions than practices with 10-19 physicians, and practices with 3-9 physicians had 27% fewer admissions.  The researchers posit that independent practice associations (IPAs) may be a viable alternative to produce better results in the near term.