This paper aims to present and discuss the innovation that the Local Healthcare Authority of Piacenza put in place regarding primary and intermediate care. It presents the historical background and the starting point right after the Covid-19 pandemic and according to the Next Generation EU program and the new Law number 77. The goal of this contribution is to present the management of innovation the complexity of managing chronic patients and the challenges in making GPs accountable and more and more involved managing clinical pathways. At the end of the paper the Local Healthcare Authority of Piacenza presents its 2030 Vision and its Dream – the Sogno – so to never stop improving the quality of care and having a ONE Health approach.