Chapter 9 analyses Regional Holding Companies (Capogruppo Regionali). Since 2008, the network of players that were formerly in competition gradually began to deliver healthcare services under the coordination of regional health holding companies. The shift from a competing network to a coordinated system with centralized planning aimed at limiting expenditure and maximizing social gains, has meaningful consequences for the institutional settings of the holding. This study identifies four typologies of regional healthcare holding companies that differ based on the types of governing powers assigned to the regional holding and the responsibilities and autonomy left to the subordinate healthcare organizations. The regional holding can have a staffing/support, planning, strategic, or executive role. This study classifies the institutional setting of six Italian regional governments (Emilia Romagna, Friuli Venezia Giulia, Liguria, Lombardia, Veneto, Toscana) taking into account the time variable and analyzing the planning and management of three key processes (personnel selection; bids for health technologies; logistics). Overall, there tends to be a three steps process that some regions are applying consequentially while other, simultaneously. The steps are the centralization of purchases and logistics; the creation of a network of healthcare organizations with holdings that have planning responsibilities; the assumption of strategic and executive responsibilities by the regional holding. The main critical elements are, on one side, the need for specialized competencies and sufficient human resources and, on the other, the inclusion of private healthcare providers in the transformation.