Global Review of Primary Care Delivery Models as Applied to Accountable Care Strategies

Context: This is a review of the global experience of applying a range of PHC and health status management strategies as part of an overall accountable care system strategy. It provides a critical analysis and comparison of the experiences from developed countries. The objective of this study is to identify the key elements of success in delivering accountable primary care systems to serve as guidance to design and effectively position PHC models within accountable care strategies. The target audience is policy makers tasked with the design and implementation of an effective PHC model that can drive the transformation of a health system toward accountable care. Methods: Global literature review identified commonalities of effective PHC and essential components of the more developed or high-functioning PHC and integrative strategies and models. Findings: Globally, well-designed and well-executed primary care delivery plans have commonalities in their roles under accountable care in terms of purpose, aims, functions, and beliefs. One commonality is a sufficiently sized, well-designed, and well-distributed network of primary and secondary health care services in close proximity to the populations served. There are six key characteristics of High-Functioning PHC Models within Accountable Care Systems. There are 14 Critical Success Factors in PHC Capabilities and Performance. PHC service design and delivery is highly varied, therefore it is necessary to ask 13 core questions to develop a more detailed approach to work plan development and execution. Four case-based observations offer insight from a review of US integrated health systems. Conclusions: Providers and accountable leadership should adopt an expanded and holistic definition of primary care and its role in a health system’s mission. Leadership and management of primary care strategies for integrated health systems should develop competencies and skills to effectively capture, interpret, and display the total value received for the PHC resource investments.