The changes inherent in the Affordable Care Act (health reform) have extensive implications for all aspects of the U.S. health system: financing, service delivery, public health, coverage and access, quality, and ultimately, well-being. During this critical period of health system transformation, public health has the opportunity to address both technical and adaptive challenges, think systemically, and begin to lay the groundwork for strategic action and innovation. This tool has been designed for public health practitioners at all levels to practice using adaptive thinking as they grapple with the many questions presented by health reform and health system transformation.