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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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Previous Chapter: Appendix C: Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015

Page 413 Cite

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.

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.
Congress	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

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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
Health Resources and Services Administration	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

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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