Table 3.

Key Primary Health Care Organization (PHCO) Structures

Domain	Australia Medicare Locals1	Colorado Regional Care Collaborative Organizations2	North Carolina Networks3	Oregon Coordinated Care Organizations4
What kinds of entities typically form the PHCOs?	General practices; partnerships between practices, nongovernment organizations, state and/or local governments	Partnerships between hospital systems and practices; broad-based coalitions of public and private providers, Medicaid health plans	Physician practices; hospitals; partnerships between practices, and hospitals	Physician practices; partnerships between practices, hospitals, and/or community-based organizations
Governance	Independent public companies limited by guarantee, managed by skills-based boards, subject to the Corporations Act 2001. Must have demonstrated record for managing risk and efficient and effective use of managing public funds. Governance arrangements should promote strong linkages between Medicare Locals & local health providers, Local Hospital Networks, and community members	Regionally based organizations, some Limited Liability Companies (LLCs), and a mix of nonprofits and for-profits with a minimum of 3 years of recent Medicaid experience as well as coordinating and delivering or commissioning the delivery of comprehensive health care services spanning both the inpatient & outpatient continuum of care. Must form a Performance Improvement Advisory Committee, with a formal membership and governance structure, to allow for provider and client input.	Local or Regional, 501(c)(3) nonprofit organizations and 1 county health department. Networks are comprised of health care and support service providers who share resources and execute care improvement initiatives. Networks are required to have a skills-based board and include several committees including a steering committee that includes primary care physicians & representatives from local hospital, health department, social services, & other community health organizations.	Community or statewide organizations, mostly Limited Liability Companies (LLCs), and a mix of for-profits and nonprofits. May contract with counties or with other public or private entities to provide services to members. Must have experience and capacity for managing financial risks. Governing body must include members that have financial risk in the organization and at least 2 health care providers in active practice.
Authority	Federal and state Health Reform Agreement	State legislation, federal Centers for Medicare and Medicaid (CMS) state plan amendment	Federal CMS waiver	State legislation, federal CMS waiver
Objectives	1) Improve the patient journey through integrated and coordinated services; 2) Support clinicians and service providers to improve patient care; 3) Identify local health needs and develop responsive services 4) Facilitate the rollout of new national primary health care initiatives; and 5) Promote strong governance and efficiency.	1) Expand access to comprehensive medical homes 2) Integrate and coordinate access to physical, behavioral health, and social services 3) Ensure satisfaction and engagement of both patients and providers 4) Apply data and analytics to support transparent, secure data sharing and monitoring and measurement of health care costs and outcomes.	1) Form networks of community physicians, hospitals, health and social services departments, etc. to plan and to develop programs to meet local health needs 2) Use population management approaches to work with providers to improve outcomes 3) Provide care and case management support to help physicians manage complex patients 4) Give feedback and data to inform care	1) Integrate and coordinate benefits and services 2) Provide local accountability for health and resource allocation and improve health outcomes through meeting state-defined metrics goals; 3) Manage a global Medicaid budget tied to a sustainable rate of growth 4) Provide standards for safe & effective care.

¹Department for Health and Ageing. Guidelines for the establishment and initial operation of Medicare Locals & Information for applicants wishing to apply for funding to establish a Medicare Local. Canberra, Australia: Department for Health and Ageing; 2011.

²Colorado Department of Health Care Policy and Financing. Request for Proposals RFP # HCPFKQ1102RCCO Regional Care Collaborative Organizations for the Accountable Care Collaborative Program. Denver, CO: State of Colorado; August 2010.

³Community Care of North Carolina. The Evolution of Community Care of North Carolina. 2015. http://commonwealth.communitycarenc.org/about/evolution.aspx. Accessed May 5, 2015.

⁴The State of Oregon Health Authority. Request for Applications for Coordinated Care Organizations (CCOs) RFA 3402. May 2012. https://cco.health.oregon.gov/RFA/Documents/CCO_RFA_without_separate_documents_Final_3-18-12.pdf. Accessed June 4, 2015.