Communities Shaping a Vision for America's 21st Century Health & Healthcare

Community Vision Project Overview

Wye River Group on Healthcare (WRGH) has executed a series of Healthcare Leadership Roundtables, or "listening sessions," in 10 diverse communities around the country, designed to elicit and capture the key attributes of contemporary American healthcare values. The goal is to develop a healthcare agenda that transcends politics and sector competition by starting with community discussions of our healthcare values and how they should shape our healthcare system.

During these roundtable discussions, community health care leaders were not asked their views on specific policy issues. Instead, they were asked deeper, more fundamental questions, such as whether there is, or should be, a social contract for health care in this country. Participants proved eager to explore these questions, which are rarely asked in the usual forums on health care policy.

This project is fairly unusual - in fact, unprecedented - in its effort to understand how health care stakeholders and consumers view the values and principles underlying our health care system. We used community-based discussions to explore these issues and asked participants to set aside the politics and sector competition that have shaped so much of our health care policy in this country.

What we discovered was a surprising degree of interest and willingness at the community level to offer honest viewpoints about the values and principles in health care, to bring up frustrations and specific challenges, and to pursue collaborative efforts to address key health care issues in their community.


The Healthcare Leadership Roundtables were held in 10 communities around the country between July 2002 and June 2003. In each community, WRGH assembled a diverse cross-section of public and private stakeholders with detailed knowledge of health and health care. They included physician leaders, hospital and health system executives, community and public health officials, pharmaceutical and pharmacy representatives, business leaders, consumer representatives, and government officials. We also worked to ensure that important constituencies such as the elderly, the uninsured, minorities, and people with chronic illnesses were well represented. We believe that, collectively, these leaders have a solid understanding of the health and health care challenges communities face.

Each of the roundtables was a three-and-a-half-hour meeting focused on the shared values and principles that should provide the foundation for health policy in this country. In these discussions, we explored participants' views on the social contract for health care - both as it currently exists and what they believe it should be. We challenged them to define the attributes of a well-functioning health care system and the role that each sector would optimally play in creating and maintaining that system. We asked them to reflect on consumers' expectations of health care. We also tried to raise community leaders' sense of themselves as catalysts for positive change in health care.

Following each roundtable discussion, a professional writer distilled the comments into a "community profile" highlighting the shared values and principles articulated in each community. Draft versions of the community profiles were shared with roundtable participants for their comments, corrections and additions prior to being finalized. The 10 community profiles are included in this report.

As another result of the roundtable discussions, we have developed a roster of 20-25 leaders in each community. This is a practical list of advisers from different sectors in each community who are willing to help us move closer to addressing issues of common concern in health care. Our intent in Phase II of this project is to collectively engage these leaders in activities designed to bridge the gap between local concerns and national public policy.


The 10 communities in which roundtable discussions were held were carefully chosen to reflect our nation's diversity - not only its diversity of peoples, cultures and values, but also its diversity of health care challenges. The selected communities varied by geography and size, ranging from large metropolitan areas to smaller cities and rural communities, and by cultural and ethnic diversity. The communities also represented a range of regulatory environments, from communities in heavily regulated states to those in states with moderate or minimal health care regulations. We also selected communities that represent both ends of the spectrum when it comes to the percentage of uninsured residents.

The final criteria related to health care costs and quality, using data from the Dartmouth Atlas of Healthcare and a Health Care Financing Administration (HCFA) study published in The Journal of the American Medical Association (JAMA) in the summer of 2000. We selected communities where health care costs per enrollee were much higher than national averages as well as communities where costs were several times lower than national averages. Additionally, some communities were located in states that had been rated very high with regard to quality of care, while others were in the lowest bracket, according to the HCFA study.

Roundtable discussion participants were chosen with equal care. In addition to the chief executive officers and senior executives invited by project sponsors, WRGH recruited a broad cross-section of leaders from each community we visited. Our goal was to balance participation across health care sectors and from a public/private perspective, endeavoring to ensure that the "consumer voice," reflecting the composition of the community, was represented. With the assistance of our supporting organizations, we were able to reach local health care leaders such as public health officials, Medicaid directors, directors of community health centers, representatives from consumer organizations, culturally focused groups and local professional associations, civic thought leaders, and local employers.


WRGH traveled to each site 4-6 weeks in advance of the Healthcare Leadership Roundtable in order to gain a meaningful understanding of the unique cultural aspects and health care marketplace dynamics in each community. During the site visit, we met with a broad array of community opinion leaders from virtually every health care sector, both public and private, as well as individuals representing key consumer groups. Through a series of one-on-one meetings and interviews, we elicited their concerns and ideas and developed a sense of the local culture, marketplace dynamics, and cross-sector relationships that shape each community's approach to health care. The one-on-one meetings also helped us identify successful community partnerships that became the basis of our "case studies" in this report, which are intended to provide knowledge transfer among communities and constructive change on the national level.


Although this project focused primarily on discussions held at the leadership level in these 10 communities, in 6 of the communities we also conducted informal meetings with groups of local citizens. We wanted to elicit their opinions to balance and supplement the views of their community leaders.


Midway through its 10-city tour, WRGH began to develop a circle of advisers - leaders chosen from different health care sectors and communities - to help us develop recommendations and potential "next steps" in addressing common issues that arose in community discussions. Our intent was to engage these leaders in a process aimed at bridging the gap between local health care issues and a broader agenda with national application.

To organize this aspect of the project, we created "advisory boards" around 6 health care topics - cultural change, access, information infrastructure, incentives, quality, and the role of public health. The advisory board members participated in a series of meetings by telephone that were aimed at identifying opportunities for focused initiatives to be launched in the communities. The boards each developed a topic-specific report describing the crux of their particular issue and suggesting several potential next steps for collaborative action at the community level. The advisory board reports are included in this report.


After roundtable discussions were held in all 10 communities and the advisory boards wrapped up their work, WRGH hosted a retreat July 9-11, 2003, at the Aspen Institute Wye River Conference Center in Maryland. Two key participants from each roundtable discussion and representatives from our sponsoring organizations were invited to participate in the "shared vision" retreat, where draft chapters of the report were reviewed, discussed, and edited.


To announce the "shared vision" that arose from this project, WRGH organized a national summit designed to showcase the findings of the 10-city tour and launch a national dialogue on health care among the American public, policymakers and health care stakeholders. The summit, held September 23RD, 2003 in Washington, D.C., provided an opportunity for community and national leaders from all health care sectors to share their insights into our health care future and to articulate their collaborative goals.

PHASE II: Sharing the Vision:

In the second phase of this project, we plan to build on the momentum created in Phase I by working with our sponsors, national leaders, and local community leaders to develop and execute a campaign to raise awareness and engage the public in constructive dialogue on health care challenges; create channels for national health policy leaders to gain insight from communities; and demonstrate local solutions from ten diverse model communities that have the potential to be replicated on a national level.

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