THE PROGRAMS THAT have been implemented by PeaceHealth and Intermountain Healthcare differ in several ways. For that reason, this review will address them separately. PEACE HEALTH The PeaceHealth program addresses the needs of individuals with serious conditions that are managed within a complicated healthcare delivery system. Like politics, all healthcare is ultimately local. However, required resources are not always available locally. As a result, a lot of time and knowledge is often needed to navigate through the system to match needs to resources. This article does not define community in great detail. Specific examples of community successes would give the reader greater insight into its structure and function. Also, each community is unique and constantly changing. Job changes and life events can result in moves - sometimes across town, but sometimes across the country. Community-supported programs must be able to address these population changes. Competition is a basic principle of capitalism and helps form the backbone of our economy. Competition helps control prices and is a catalyst for advances in technology. The goal, of course, is to maximize the number of patients who can benefit from this competition - and minimize the number that get lost in the system. Many readers will take exception to Deming's belief that the United States has the poorest quality of care at the highest cost. The reasons for cost increases are many and they are complicated. But quality is another issue. If American healthcare is poor, why do so many people from around the world come here when they need care that requires great skill combined with advanced technology? The author implies that there is a lack of cooperation within the health system. The issue is not always one of cooperation, but rather, identifying who should take ownership of the problem and be responsible for solving it. Everyone plays a role-doctors, patients, families, and insurers. But ultimately, someone must be identified as taking the lead. This lead person will be different with each patient, but at a high level, the processes that are used to identify and access resources should be similar. A community disease registry is an excellent tool that allows providers to have access to critical informa- tion. Including patients on the Pursuing Perfection (P2) program teams brings further value by obtaining input from those who receive care. It also helps to build credibility and confidence in a system that frequently utilizes protected health information. The author mentions stories that were told by patients about the failings they identified within the health system. Specific examples of such failures would provide the reader with a greater understanding of what they are and how they can be addressed. The development of Clinical Care Specialists adds further value by providing patients with someone who understands the system and its language. It also enhances the patient's ability to access important information and tools that can help to improve their health status. In some cases the CCS can be the point person/owner of the patient's concerns, as noted above. It should be pointed out that many patients currently have access through their insurers to case managers who provide these types of services at no charge. In addition to care management services, insurers also provide resources, tools, and information on many conditions and topics. Examples of how such information can be made available include mailings, online programs, DVDs, and telephonic coaching. The shared care plan provides yet another tool that patients can use to enhance communication and share information. No detail was provided regarding how this system interfaces (if at all) with a patient's personal health record and/or their physician's electronic medical record. Also, because Internet access varies among patients and their families, widespread use of this technology may be limited. …