Back to the future: partnerships and coordination for community health

In the current tumultuous health care scene, competitive health plans and capitated delivery systems are becoming the driving forces in the health care marketplace. Although these plans may be successful in containing costs, their competitive nature prevents them from providing leadership in comprehensive, coordinated initiatives to benefit the entire community. In contrast, executives and trustees at the frontiers of health services management are reaching beyond the current scene toward a vision of community care networks. They are taking incremental steps to coordinate care of patients, enrolled populations, and communities--both within and among independent organizations in the public, for-profit, and not-for-profit sectors. As they bring increasing competence in coordination to bear on complex problems of long standing, a health care system that actually delivers more for less to all is a real possibility. My historical perspective, dating back to the studies of the Committee on the Costs of Medical Care (1928-1932), convinces me that community coordination is the missing element in moving from our current fragmented health system to an ever more effective system. This article suggests that the CCMC was on the right track in recommending that every community have an agency to exercise coordination functions, relying on the power of knowledge and persuasion rather than control. Presented here are details of how to organize and manage such an entity as well as a discussion of the nature of the leadership and the incentives required to overcome obstacles to this essential approach.