Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund's Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multistakeholder collaboration was an important factor in achieving community health or health system goals. There were also mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, regional investment and cooperation to apply information technology and engage in community outreach, and a shared commitment to improve the accessibility of care for underserved populations. State policy and national and local funding programs also played a role in expanding access to care and providing resources for innovation. The experiences of these regions suggest that stakeholders can leverage their unique histories, assets, and values to influence the market, raise social capital, and nudge local health systems to function more effectively.