In the United States, health system change occurs as the interaction of politics and policies is played out and pushed forward by individuals and organizations taking action in their local communities and markets. This article provides context and descriptive information about a model of local health care reform that is being tested in twenty-five communities around the nation. We introduce a value-based model of community-responsive health system change, the Community Care Network (CCN) Vision. We briefly describe a national demonstration program that is testing this model between January 1996 and the end of 1998. We offer several ways of looking at the local and regional multisectoral partnerships that are attempting to demonstrate the CCN vision. We look at their composition, the kinds of actions in which they are engaged, several example challenges and responses to them, and we give several examples of schools becoming part of the health system of last resort. Finally, we present some early ideas on how the local actions described here may influence (and be influenced by) the political and policy contexts in which they occur.

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