Improving community-based prevention by transforming managed care organizations into health improvement organizations.

Large nongovernmental health systems are taking over much of the direct delivery of healthcare to populations previously served by health departments. This article explores ways in which governmental and academic public health systems can help maximize positive effects of this trend on community health. The experience of Group Health Cooperative of Puget Sound is reviewed, with particular attention to its prevention structure and work to address tobacco use. An ideal preventive health improvement system model is presented, and future directions and key lessons are explored.