1. Where Are We Going? Are We All Rowing In the Same Direction? Peter Rutherford, MD

2. Key Thoughts We are all in this together. Success will be measured by the overall improvement in “health” in our communities, in this region. No one organization can do it all, and do it well. (Cost, Quality, and Access). We have to prove that what we do, we do well.

3. Key Thoughts Patient/community engagement is paramount. We can not have participants who have a siloed agenda. To quote Lee Iacoca “Lead, follow, or get out of the way” We need to focus on a few things at a time, do them well, then move on to the next thing. Equally, we must decide what we are not going to do. We need to go to our patients where practical. Expecting them to come to us all the time does not build trust or engagement

4. Key Thoughts Funding now is in silos, that will not continue long term. There will be a single pot, and outcomes will determine who has access to the pot. The need is not just medical, and psychiatric. It also is engagement, education, social, economic. The best outcome and the most sustainable will include the appropriate components of all of these.

5. Transparency, Communication, Coordination and Accountability are Paramount What are you doing? Why are you doing it? Who are you providing it to? Who are you working with? How are you measuring “success”? What are you not doing?

6. Confluence Vision Health is a regional issue Health is not just medical. It is psychiatric, social, economic, educational. It can not be siloed We need to use the special skills of groups, organizations, people to the “top of their license/skill set. We need a tiered approach. What can be done locally, what can be done where most helpful to the patients, where patient engagement is best, is where it needs to be done. Where it needs to be aggregated to fully utilize people or equipment, do it. Where we can not do it well, find who can and make sure we get our patients/ our community members there, and then get them back as close to home as possible for continued care. We have to measure what we do. If we do not measure, we can not tell if we are improving or not. There is a financial reality. We do what we can.