Upper Valley of New Hampshire & Vermont The Upper Connecticut River Valley of New Hampshire (NH) and Vermont (VT) is home to Dartmouth College and the Dartmouth-Hitchcock Medical Center—major players in the regional economy and the local health system. While there are pockets of poverty in this community of 140,000, residents generally are above average in education, income, and health status. But the region faces other challenges, including high per-capita health costs, rapidly declining Medicaid reimbursements, rising unemployment, an aging population. Additionally, the region’s rural nature creates challenges for accessing primary care. Aspiring to a healthy and sustainable local economy, leaders from Dartmouth challenged Upper Valley residents to join together in addressing high healthcare costs and imagining a stronger future for the entire region—and they turned to ReThink Health for technical assistance. We worked with local champions to launch an initial planning team that included leaders from major regional employers, the social service sector, and members of the Upper Connecticut River Valley community, Dartmouth College, and Dartmouth-Hitchcock Medical Center. Working closely with this team, ReThink Health helped launch a series of community dialogues, engage key stakeholders, and initiate regular meetings to think through challenges and guide progress toward a genuinely shared strategy for collaborating to transform the region. We also partnered with members of the leadership team to interview key regional stakeholders to both identify potential leaders and inform the design of a strategic approach to improving health and health care in the Upper Connecticut River Valley. That effort resulted in a white paper, which was distributed throughout the community to help build greater interest in the initiative. Rethinking the Regional System for Health ReThink Health also helped the group design and execute two major gatherings of more than 80 community leaders, first to formulate a coherent vision for the region, and then to explore change strategies and articulate areas for innovation. The ReThink Health Dynamics Model was an important tool in this process. It helped the community focus on priorities related to behavior, coordination of care, and payment reform—particularly global payments. The ReThink Health team supported the design of a collective decision process so that, from these community gatherings, the initial planning team launched additional teams responsible for leading different aspects of the effort going forward. Now in Phase 2, this long-term initiative has begun moving into implementation, including the creation of a permanent office and the hiring of key staff. ReThink Health helped the initial planning team design a structure and process for the long-term stewardship of resources in the region, including mechanisms for citizens to participate in setting priorities and leading change. Further, a large-group gathering in late 2013 saw the launch of three “circles of innovation” working groups, which were formed to lead efforts on: Coordinating care in the Upper Valley, including between medical care and social services; Engaging citizens and workplaces in healthy behavior programs to improve population health; and Altering the payment system in the region toward global payments, and creating a system for capturing savings from change efforts and reinvesting in upstream, health promoting activities. As the initiative evolves, local leaders are taking greater ownership over the project and developing new organizational and governance models. They also are continuing to work with ReThink Health to focus their efforts on designing, implementing, and evaluating programs that will provide system-wide effects in targeted areas of interest.