native models for achieving greater integration of personal and population health services and innovative approaches to the financing and delivery of health services, with the goal of meeting the six quality aims of the Quality Chasm report. The Agency for Healthcare Research and Quality, working collaboratively with the Health Resources and Services Administration, should ensure that the lessons learned from these demonstrations are disseminated to other communities, both urban and rural.

These demonstration projects would involve the establishment of collaborative structures, community-based prioritization of potential investments in health, and the development of communitywide population health programs. As discussed in Chapter 3, there will be a need for communitywide quality measurement and monitoring systems that include measures of both population health and the quality of care provided through the health care delivery system. Some of these demonstrations may well involve the implementation of new payment models, for example, a capitation payment approach administered at the community level, encompassing financing for both population and personal health. Additional work is needed to identify alternative payment models that are consistent with the committee’s integrated approach, and to describe how such models might be tested through demonstrations in rural communities.

Residents of rural America are diverse, but one thing they generally do have in common is a strong sense of attachment to their community. This community orientation, combined with the smaller scale of rural health, human services, and community systems, may afford rural communities an opportunity to demonstrate more rapidly the vision of balancing and integrating the needs of personal health care with broader communitywide initiatives that target the entire population (IOM, 2003b).

Efforts should also be made to build stronger rural communities that mobilize all types of institutions (e.g., health care, educational, social, and faith-based) to both augment and support the contributions of health professionals. As discussed above, to achieve the greatest improvement across all six quality aims, rural communities will need to focus greater attention and resources on improving population health. Doing so will necessitate building coalitions. Some coalitions will involve stakeholders from within the health care sector; for example, the providers in a community might pool resources to sponsor a communitywide education program aimed at the prevention and early diagnosis and treatment of diabetes. Other coalitions will engage stakeholders outside the traditional health care sector in



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