As accountable care organizations proliferate across the nation, delivery systems still struggle to balance quality improvement, cost containment, and migration toward accountable care. This paper describes the phased approach where the University of Florida Health Science Center and Shands Teaching Hospital and Clinics, Inc, and Orlando Health have jointly developed a series of clinical and health services that are of the highest quality and are offered at the lowest cost. The result is a regional collaborative that will be the foundation for a regional accountable care organization, first leveraging clinical core competencies, then moving to a more integrated model.