Response: Re: Journal of the American Board of Family Medicine Issue on Communities of Solution

We appreciate the thoughtful comments of Burns and Gottlieb¹ and agree with many of their points. Throughout our work examining the Folsom Report,² we have noted many of the same pitfalls regarding current fledgling communities of solution (COSs): the lack of rigorous research, outcomes data, and nationwide or regional networks. Burns and Gottlieb's cogent suggestions to further the rigor of COSs and assess outcomes are critical next steps.

Health care providers are crucial members in a COS. While some barriers to provider inclusion do exist, providers often choose not to participate because of other pressing work or lack of payment for community-focused work. Alternatively, providers do not necessarily have to lead a COS but can join instead as partners. Groups may more willingly add providers to their invite lists if the providers are merely one of the stakeholders.

The concept of any particular local COS is not always scalable; it may not provide evidence for the same solution in another COS. However, there is a need for a lattice that can connect COSs for ideas, support, funding, research.

Health insurers and hospitals also play an important role in concordance with their mandates for community benefits. Funding agencies and foundations could consider supporting a national research network to inform the coalition of public health and primary care across jurisdictions. Hopefully future work will feature COS outcomes on population health.