Another example of extensive community engagement is the Southcentral Foundation’s Nuka System of Care. The Southcentral Foundation has ensured that community members are at the center of all health system decisions and changes. Since 1999, the Alaska Native Tribal Health Consortium has owned and managed the Alaska Native Medical Center meaning that patients have full purview over the operations of their health care system.¹ All decisions are made with strong consideration of the customer-owners and the ethos of the organization. For instance, stakeholders considered instituting a gatekeeper model for access to specialty care to help improve cost-containment, but this was ultimately rejected because it did not align with the health system’s focus on the autonomy of customer-owners.² This model of care requires significant reorganization of management and financing but highlights the range of engagement that health systems can foster with community members.