With articles about health system mergers and acquisitions becoming a regular fixture in business publications, why is it that anticipated benefits of mergers remain so elusive?  Despite countless hours of time spent on identifying the “perfect” partner or target, conducting due diligence, surviving hard fought negotiations, and executing exquisitely detailed post-merger integration plans, the majority of mergers fail to deliver against projections.  The inability to realize desired results after spending millions of dollars and thousands of hours on merger-related planning sparks board room consternation and, worse, concerns about leadership abilities of executive teams.  Post-merger integration challenges often stymie an organization’s ability to successfully differentiate itself with increasingly value-conscious consumers, payers and employers – reducing organizational agility and the ability to meet market demands for better care at lower cost.