The American Hospital Association’s report, Hospitals and Care System of the Future, describes the transformation of health care delivery from first curve to second curve, driven by a shift from volume driven to value-driven payment systems. While there is no single “end state” model that suitable for all organizations or communities, the report offers a compelling vision of “care systems” that are accountable, integrated and coordinated around patient and community needs.” Hospitals and care systems will not be the same. Compared with a typical hospital today, a care system is likely to span the continuum of care (acute inpatient, outpatient, home, school/workplace, rehabilitation, sub-acute facilities), focus on promoting wellness as well as treating illness, be accountable for costs as well as quality, and have physicians deeply involved in leadership, to name a few distinctions. Consequently, governance of care systems also will differ from hospital governance or even current governance in many hospital-based health systems. The survey tool and discussion stimulator on the next page extracts several hypotheses about governance of the future from the Hospitals and Care Systems of the Future report. Questions after are designed to stimulate board discussion about future governance.