The 2016 edition of The Commonwealth Fund’s Scorecard on Local Health System Performance finds continuing wide variation in health and health care across U.S. communities. In its assessment of 36 indicators of access, quality, avoidable hospital use, costs, and outcomes, we see that health care improved more than it worsened between 2011 and 2014 in nearly all 306 local areas. Gains in access to care, quality, and efficiency often corresponded to implementation of public policies, such as the Affordable Care Act, and to quality improvement collaborations. But lack of progress on many indicators suggests further efforts are needed. Notably, mortality rates were mostly unchanged, and obesity rates rose in 111 of 306 localities. Health system performance is often linked to resource availability, with areas that have a high proportion of low-income residents tending to rank lower. Exceptions to this suggest, however, that local improvement efforts can succeed despite socioeconomic challenges.