“Health starts in the home, the community and importantly in cities and begins with breaking down silos. Improving health outcomes in Cincinnati required the collaboration of 5 employers, 3 insurers, 3 local agencies, 3 national agencies, 5 hospitals, thousands of doctors and nurses and most importantly the 2.2 million health consumers living in the city. Only with this collaboration could advanced payment innovations, IT, quality improvements, patient center medical homes and consumer engagement tools really work to improve health.