In September 2013, the Institute for a Sustainable Future hosted a Duluth, Minnesota conference for nearly 200 leaders active in healthcare delivery, public health, hospital administration, and community service organizations across the state. This paper builds on key lessons learned at the event and explores how the Affordable Care Act’s requirements for community engagement by hospitals can be directed to improve community health and vitality. It emphasizes how placed-based strategies can improve health outcomes, including linking anchor institutions to local procurement, employment, and housing initiatives.