The most critical health care challenges in our community are the rising cost of health care, the increasing fragmentation of care and the decreasing availability of primary care providers. Our health systems need to work collaboratively to serve community needs for sick and well care.

I'm focusing on helping the providers at Columbia Park Medical Group understand what we can offer Fairview and vice-versa in our new relationship with Fairview.

We're trying to balance focus on the patient and what's best for consumer needs with succeeding in a competitive environment.

Deb DeMarais, MD, pediatrics; president, Columbia Park Medical Group

In the United States, we often want Tiffany-style health care at Costco prices. At the same time, the health care system struggles with rising insurance prices, quality issues, pharmaceutical costs and an ever-expanding Medicare population.

Our challenge is motivating patients to be active partners in their health care, so they do not expect physicians and the health care system to do everything for them. If we are successful in partnering with patients and convincing them to be accountable for their health care, issues like insurance costs, pharmaceutical costs and quality of care may fall in line.

Mark Nielsen, MD, internal

medicine, Fairview Oxboro Clinic

The biggest challenge that health care faces is communication between providers and patients and across specialties and disciplines. Health care delivery is no more a one-way street. We, as care providers, encourage patient literacy and informed decision-making. Also we need to cross the boundaries of specialty care and break the silos of isolation to complement each other's expertise.

We need ongoing dialogue to focus on improving quality of care and life for the people we care for.

Seema Maddali, MD, hospitalist, Fairview Southdale Hospital

I've read that as many as one-third of all tests and treatments performed are not proven efficacious-for example, prescribing estrogen in an effort to prevent women's heart disease. It's hard for doctors to scrutinize the data critically. We need simple decision aids to help us discuss important choices with patients.

For example, research shows that only five patients with diabetes out of 100 will avoid a heart attack using statins, while 95 percent would not change their outcomes either way. Working with patients using high-quality tests and treatment will help save the system from financial collapse.

Kevin Kelly, MD, family practice, Riverside Family Physicians