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Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (2021)

Chapter: Appendix D: Three System-Level Tables of Actors and Actions

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Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
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Appendix D

Three System-Level Tables of Actors and Actions

Macro System Level
Actor Action
Congress 2.2: Create new health centers, rural health clinics, Indian Health Service facilities, etc.
3.2.B: Support community-based training with graduate medical education payment
 
Accrediting organizations 2.5: Help practices embrace community-oriented care models
 
Primary care professional societies, consumer groups, and philanthropies 5.3: Regularly track progress and disseminate a “high-quality primary care scorecard”
Meso System Level
Actor Action
State governments (including state Medicaid programs) 1.4: Implement payment reform
2.3: Publish performance on Medicaid standards
3.1.C: Incentivize care team diversity
3.2: Increase support for training in community practices
Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Actor Action
U.S. Department of Health and Human Services 2.2: Create new health centers, rural health clinics, Indian Health Service facilities, etc.
3.1.B: Partner with the U.S. Department of Education to increase opportunities for under-represented students
3.2.B: Support community-based training with graduate medical education payment
3.2.C: Expand graduate medical education funding beyond physicians
5.1: Establish a Secretary’s Council on Primary Care
5.2: Form an Office of Primary Care Research at the National Institutes of Health and prioritize research funding at the Agency for Healthcare Research and Quality
 
Health Resources and Services Administration 3.1.C: Incentivize care team diversity
3.2: Increase support for training in community practices
 
Office of the National Coordinator for Health Information Technology 4.1: Develop the next phase of electronic health record certification standards
4.2: Adopt an aggregate patient data system
 
Centers for Medicare & Medicaid Services 1.1: Support payment models that promote the delivery of high-quality primary care
1.2: Shift from fee-for-service to hybrid reimbursement
1.3: Increase portion of primary care spending
2.1.A: Help beneficiaries declare a usual source of primary care
2.3: Ensure adequate access for Medicaid beneficiaries and provide assistance to agencies
2.4: Make permanent the COVID-era rule revisions
3.2: Increase support for training in community practices
4.1: Develop the next phase of digital health certification standards
4.2: Adopt an aggregate patient data system
 
U.S. Department of Veterans Affairs 3.2: Increase support for training in community practices
 
U.S. Department of Education 3.1.B: Partner with the U.S. Department of Health and Human Services to increase opportunities for under-represented students
 
Commercial payers 1.1: Support payment models that promote the delivery of high-quality primary care
1.2: Shift from fee-for-service to hybrid reimbursement
2.1.A: Help beneficiaries declare a usual source of primary care
 
Publicly and privately owned health care organizations 2.1.B: Empanel uninsured patients in the system
3.1.A: Support and train non-clinician team members, including caregivers
3.1.C: Incentivize care team diversity
3.1.D: Develop a data-driven approach for tailoring to community needs
Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Micro System Level
Actor Action
Individual primary care practices 2.1.B: Empanel uninsured patients in the system
2.5: Embrace community-oriented care models
3.1.A: Support and train non-clinician team members, including caregivers
 
Patients 2.1.A and 2.1.B: Declare a usual source of primary care
Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×

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Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Page 413
Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Page 414
Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Page 415
Suggested Citation:"Appendix D: Three System-Level Tables of Actors and Actions." National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. doi: 10.17226/25983.
×
Page 416
Next: Appendix E: The Health of Primary Care: A U.S. Scorecard »
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High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.

Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern.

Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs.

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