What does it take to break from business as usual? For starters, it takes enormous ingenuity and a great deal of bravery. In order to break from entrenched siloes and move toward an integrated, dynamic, and high-functioning health ecosystem, leaders first need to want change in their region. For that reason, Ventures is working with communities that have demonstrated a unique blend of the ambition, ability, and appetite needed to truly advance transformation and generate inclusive health value. But even the most innovative efforts face immense challenges and have few examples to follow as they forge new paths. In fact, those groups that have the greatest ambitions of moving from health system improvement to true transformation often face particular barriers. Having already achieved significant progress, the “low-hanging fruit” has been harvested and major “win-wins” have been achieved. But after these hard-won achievements, enthusiasm can wane and short-term funds are exhausted. Those partnerships that continue their work in the face of these barriers are committed to pushing through to reach their long-term goals. After close to a decade on the ground in over 85 regions across the country, we have learned a lot about what can work and what may not along the often messy journey of improving health at the community level. ReThink Health’s Pathway for Transforming Regional Health draws on our experience and highlights what that journey might look like. The Ventures project itself sets out to identify common pitfalls and suggests what aspects of stewardship, strategy, and financing might build momentum. What stalls progress? Oftentimes, successes in the early stages of transformation create predictable pitfalls in later on. Pitfalls can derail progress, lead to missed opportunities, and keep a collaborative effort from achieving a bigger vision. Here are some that the Ventures communities will focus on in the coming years. Mismatch between vision and strategy. Oftentimes, partnerships have a bold goal to comprehensively transform the community but the programs and projects they are pursuing will not create the change they are looking for. If a bold vision is going to be achieved, the projects being pursued need to build toward that bold vision. For example, a partnership may have a vision to dramatically improve health for all community residents, but their portfolio focuses primarily on promoting healthy behaviors, such as healthy eating and physical activity. A comprehensive agenda to reach this vision would include “downstream” health care reform efforts (like care coordination and access) and more “upstream” efforts to reduce poverty. Short-term planning cycles. Most health planning efforts—whether public health or health care—have grand visions and aspirations that will take decades, but the plans they develop typically have short, three- to five-year time horizons. Real change requires planning for the long term—15 or even 30 years out—so that even as the organizations and individuals who are involved shift, there is a strategy in place to guide their efforts for years to come. The right people aren’t at the table. Well established partnerships are often led by the group of people who originally initiated the effort, which may no longer be the right mix of people and institutions. And many partnerships find they are not representative of the demographics in the communities they serve. As agendas expand and the focus of a partnership shifts, so too should the mix of leaders guiding the effort. Inadequate funding and infrastructure. Partnerships consistently report that limited funding and short-term budget cycles create huge stresses on operational infrastructure and the ability to achieve ambitious program goals. A better bet is to budget for a longer time horizon (five or more years) and rely on financing approaches and sources with a longer shelf life than one or two years. This type of sustainable financing will pave the way to long-term strategic plans and solid organizational capacity. What drives momentum? A number of competencies are particularly relevant for advanced partnerships to help ensure an upward trajectory and protect against reversals. Here are several that the Ventures communities have identified as being especially important to their efforts. Making the business case. Rarely does a group clearly state what will happen if it succeeds in closing the gap between where it is today and its long-term vision for regional transformation. A partnership with this clarity of purpose and internal alignment offers a compelling “business case” to investors, one-another, and their broader community by communicating a credible return on investment and defining the total potential value—moral and economic—of the desired change. Meaningfully engaging residents in decision-making. For a collaborative effort to succeed, residents can’t be involved in just a token way; they need to be truly engaged. It benefits everyone if there is an ongoing venue to actively engage residents in the work of the partnership, early on during idea generation and all the way through implementation. Any effort will be more likely to succeed if it reflects the priorities of individuals and resident groups, who must be involved if they are to be heard, respected, and taken to heart. Experimenting with risky ideas. It can be difficult to incubate programs that might succeed in advancing change but have risky unknowns. But as the saying goes, “Why go out on a limb? That’s where the fruit is.” Developing a practice of experimenting with risky ideas is essential if partnerships are going to develop new approaches that will help to genuinely transform their systems. Actively engaging in policy work. State and local policy shifts often are an essential aspect of change. It is critical for partnerships to develop relationships with policy makers and a habit of engaging in strategic policy advocacy to help advance their goals.