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To sustain gains from a process improvement initiative, healthcare organizations should: Explain to staff why a process improvement initiative is needed. Encourage leaders within the organization to champion the process improvement, and tie their evaluations to its outcomes. Ensure that both leaders and employees have the skills to help sustain the sought-after process improvements.

Key considerations facing a hypothetical and typical health system as it transitions to value-based payment provide a guide for systems as they undertake this transition. The health system's first step is to review its current environment and strategies and the building blocks it has in place. Next, the system needs to add more building blocks, build a financial cushion, and revise targets and dashboards. Next steps include testing value-based payment contracting, realigning incentives, implementing new care management strategies, and communicating extensively. All of these steps will be unique to each organization.