In this discussion paper, Glen Mays describes recent experimentation with population health strategies that has been spurred by the ACA and by state health reform. Population health strategies involve varied stakeholders in the public and private sectors. The evolution in the landscape of actors, along with ACA implementation and factors including economic challenges, are leading to a reexamination of how governmental public health agencies are organized, and of their activities and financing. An IOM report and other sources have described the heterogeneity of public health agencies and their activities, which in some cases include the provision of clinical health care services, and similar heterogeneity in how those activities are financed. Aside from inefficiencies, heterogeneity is problematic because it creates deep disparities in the level of health protection received by communities. Recent research has shown that because public health agencies are dependent on state and local government funding, which is heavily derived from taxes, areas with lower socioeconomic indicators experience lower financial support for public health services, with negative effects on health outcomes. Mays writes that “the growth of population health strategies provides governmental public health agencies with an opportunity to . . . pursue solutions to unwarranted heterogeneity in public health activities through three types of adaptation: substitution, synergy, and independence.” Substitution includes transitioning the delivery of some services to other settings where they can be performed more efficiently at an equivalent or better level quality. Synergy may include a range of partnerships or relationships in which the public health agency may play leading, contributing, or supporting roles. Independence refers to contexts where the public health agency plays a regulatory role and can be most effective by avoiding direct roles and responsibilities in implementing population health strategies. Each type of adaption, Mays identifies associated financing mechanisms, including gain-sharing and reinvestment strategies.