Chapter 9 of the report discusses specific means for implementation and identifies the many parties whose commitment will be necessary. This plan for implementation is guided by several perspectives that, in the view of the committee, are essential for success: the need for a coordinated strategy, a long-term perspective, and involvement of a large set of change agents and interested parties.
Coordinated implementation by many participants over time is unlikely to take place unless an entity exists whose purposes are to build appropriate coalitions, stimulate action, and monitor and facilitate implementation. To this end, the committee recommends the formation of a public-private, nonprofit primary care consortium (see Box S-1). Its broad functions would be (among other things) to
The committee's view of this entity as a public-private partnership was arrived at advisedly. Government at all levels has a deep interest in seeing the primary care vision of this committee succeed, but many aspects of the strategy proposed in this report require action and commitment by many entities in the private sector.
With the apparent demise of comprehensive national health care reform, the climate for moving ahead on a reform agenda affecting primary care might seem to be unfavorable. Yet, the pace of change in the health care systems of communities around the country remains very rapid. In those changes and the restructuring being proposed for Medicare and Medicaid, opportunities exist to make the American health care system more effective and efficient. Important parts of the agenda proposed in this report require federal action, but for many elements the key decisionmakers are to be found in the states and cities of this country, in health care plans, in educational institutions, in professions, and in private foundations. Many of these parties are already committed to a renewed emphasis on primary care. In this situation, opportunities for coalition building for implementation should be present, and that is one reason the committee has recommended establishment of a primary care consortium.
This is a time when creative effort and collaboration can influence the forces driving health care change in the directions defined by this committee. It will not be a time for weak hearts or quick fixes—but the promise of improving health care for Americans should be motivation enough to stay the course set out in this report.