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In 2007, Dr. Mark Horton took over as the head of the new California Department of Public Health (CDPH), at time when the governor, Arnold Schwarzenegger, had already identified obesity as a prevention priority in his health care reform proposal. However, it was not immediately clear how the CDPH should prioritize the spending on obesity prevention, nor how it should measure and evaluate the success of its interventions. A wide range of possibilities were on the table, accompanied by strong advocates on each side.

In January 2003, Dr. David Acheson, the new Chief Medical Officer of Health of the FDA was charged by his boss with working jointly with the EPA to develop a comprehensive set of federal guidelines for fish consumption for all Americans. The guidelines needed to balance the benefits of fish consumption with the potential risks of exposure to mercury, dioxin, and PCBs - exposures of particular concern to pregnant women and young children. The case includes an additional document entitled Mercury and Fish Consumption that provides background material and reviews of studies of mercury exposure.

"Suffolk County is experiencing elevated cardiovascular disease mortality relative to New York State," explained Dr. Humayun Chaudhry, Commissioner for the Department of Health Services of Suffolk County. Given the general affluence of the area, he finds the CVD mortality rates "a paradoxical situation. We need to determine strategies to address this high priority health issue for our county."

How can we evaluate if innovative health care ventures can do good-benefit society-and do well-become financially viable? This question is the topic of the first module in the Innovating In Health Care course book. This note and case series enables readers to conduct this kind of evaluation in the context of innovative organizations for Primary Care Physicians (PCPs). They ask the reader to evaluate which, if any, of the different innovations for organizing PCPs could have helped Health Stop avoid its subsequent failure (not revealed in the case). In addition to Health Stop's retail medical center model, the note reviews innovations that differ in location; virtual or bricks and mortar; other retail-based; and differ by payer/patient focus. The pair emphasize that success or failure is shaped by correct identification of the type of organization-is it consumer-facing, technology-commercializing, or cost-controlling?-and the alignment of that type of organization with the Six Factors in the environment that critically affect it-Structure, Financing, Consumers, Public Policy, Accountability, and Technology. Health Stop failed because it tried to become two different types of organizations-consumer-facing and cost-controlling-and thus had poor alignment with many of the Six Factors critical to its success. It is impossible to focus on more than one type. Some sort of partnership with the retail-based (e.g., CVS, Walgreens) or technology-based innovations (e.g., Aledade (see "Aledade." Harvard Business School Case 321-131), Agilon) could have helped to rescue it.