•   Having agreed-on vision, culture, and goals;

•   Community engagement in setting priorities and involvement in improving health;

•   Solid training and defined roles among the health care team members;

•   Certification and licensing that supports the new roles for population health; and

•   A learning and improving environment (including, for example, a community health improvement plan that the collaborative group agrees on and works to implement jointly).

Having these nine items, she said, can turn a good program into a sustainable program, one that will have the financial resources to succeed, the data to demonstrate success, and the community and professional buy-in to maintain momentum. “These are the pieces that get the system moving in the right direction,” she said.

Isham noted that he heard many of the panelists talk about a tension between the cultures of public health and health care delivery and the need to overcome the barriers that lead to treating them as separate cultures. Some speakers referred to analogous challenges, or signs of dissatisfaction on both sides of the cultural fence between health care and public health, including the need for payment reform in health care delivery and the need to address the problems with categorical funding on the public health context. Isham remarked on the fact that presentations listing opportunities under the Affordable Care Act (ACA) referred to the National Prevention Strategy and National Quality Strategy, two parallel, but not yet integrated, national initiatives. Isham also reiterated the conditions required for collective impact, mentioned by different speakers: a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and a backbone of support or infrastructure. Isham also commented on the importance of having an infrastructure to support population health and remarked on the fact that public health is suffering a loss of funds when they are most needed. Sanne Magnan remarked that she would add to the growing list of topics surfaced during the meeting the ability to sustain focus and the need to demonstrate return on investment—to answer the question that multiple stakeholders will ask “what’s in it for me?”—by helping stakeholders identify how they could participate and potential benefits of working together. Other members commented on the clear need to educate different health professions to understand and be able to contribute to improv-


area. Examples of integrators range from integrated health systems and quasi-governmental agencies to community-based nonprofits and coalitions.”

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