The purpose of Key Lever 5 is to design a statewide network of high-functioning primary care organizations (PCOs) that meet the needs of the state population (see Key Lever 2), provide them with a complete spectrum of care and governance principles that protect them from potentially conflicting objectives of the organizations that provide the necessary network of services, whether specialty and acute care, administrative and technical services or financial support.
Introduction
Primary care in most states is underfunded, and the symptoms are visible. The number of practicing primary care physicians is declining, hospitals are acquiring independent practices at a steady pace, and residents increasingly cannot book appointments or secure a regular source of care. Addressing this requires strengthening existing primary care organizations (PCOs) and, in many cases, building new ones, particularly in rural and underserved urban areas where none currently operate. Even a complete network of PCOs cannot alone form a comprehensive primary care delivery system. Outside partners, some already active within the state, will be needed to fill remaining gaps in clinical coverage, infrastructure, and financial support. Selecting those partners well is one of the most consequential decisions a state will make.