Health systems and clinics in San Diego have joined with public health and academic representatives to develop collaborative, innovative, and effective ways to address the region's ever-increasing health care needs. Community Health Improvement Partners (CHIP) was established in a local environment with a highly developed managed care marketplace, a diverse county population, no public hospital, and a growing number of uninsured. The catalyst for the 25-member CHIP coalition was 1994 legislation that required not-for-profit, private hospitals to, among other things, conduct a health needs assessment of its community (every three years) and prepare a community benefit plan and report (annually). After the production of the needs assessment, members implemented a priority-setting process and a combined countywide community benefit plan. Of 12 self-managed work teams formed in 1996, 7 are still meeting in some capacity--addressing access to care for the underinsured and uninsured, chronic disease management in underserved areas, community diabetes care, health education and access to care for African immigrants (new Americans), adolescent health, mental health, and violence prevention. The participation of the full spectrum and variety of health care stakeholders at the table, unique to San Diego, has enabled CHIP to serve as an open forum for frank discussions of critical and, at times, controversial health care issues. The difficulties with collaboration are not be to be minimized. CHIP hopes to live up to its aspirations to make a difference through accomplishments that are cost-effective to truly improve the health of San Diego residents.