Healthcare payment systems are so complicated that when it comes to fitting all the pieces together, hope may be the dominant strategy. Too often, policies and initiatives designed to improve healthcare quality hit a roadblock in payment systems, and the money cannot follow good intent. This is yet another issue jeopardizing rural hospital viability. Harold Miller, President and CEO of the Center for Healthcare Quality and Payment Reform, discusses how his organization works with multiple stakeholders to solve payment system problems through education, alignment and coordination. In the search for win-win-win approaches, Mr. Miller works with insurers, providers and physician groups to foster innovative and collaborative approaches, often drawing contrasting responses from private and public payers. With Bonnie Simpson Mason.