This book began with a set of questions. What are society's health needs in the twenty-first century? What kind of health system will be able to meet those needs? How can academic health centers (AHCs) and other health sector leaders help create a health system and health organizations that meet the health challenges of the twenty-first century? What capabilities should AHCs and other health care organizations develop for short-and long-term success in such a health system?

This book is based on a series of reports produced by the Blue Ridge Academic Health Group (Blue Ridge Group). The Blue Ridge Group seeks to help academic health centers better meet the needs of society. Towards that end, the Group has explored a set of pivotal health policy, leadership, and management issues and identified ways that AHCs can strengthen their viability while striving to improve the health of individuals as well as the general population. Through the course of its work, the Blue Ridge Group has developed a framework for how the health system and health care organizations should evolve to meet the challenges of improving health in the twenty-first century.

The Blue Ridge Group began its work in 1997 with three basic premises. First, demographic changes, technology, economic forces, and societal developments demand new approaches in health care delivery systems, education, and research. Second, the reforms that created upheavals in the health care delivery system during the 1980s and 1990s were primarily structured to achieve financial objectives.