Expert Insight

What Can Low- and Middle- Income Countries Learn from U.S. Primary Care?

Countries seeking to improve delivery of primary health care frequently look to models deployed by other nations as sources of ideas and inspiration. But for a number of reasons, the United States might not be the first place low- and middle-income countries (LMICs) turn to inform their own work.

Why might U.S. healthcare be an unlikely model from which LMICs can learn? While the U.S. excels in tertiary care and the use of

Photo: Southcentral Foundation
sophisticated technology for those with access, it is widely recognized that the U.S. healthcare system concentrates disproportionately on highly-specialized care centered on a specific disease or organ system, rather than primary care focused on the whole person. Further, per capita health care expenditures in the U.S. far exceed what is feasible in low- and middle-income countries.

Despite the shortcomings of the U.S. healthcare system as a whole, though, the U.S. enjoys pockets of excellence in primary care that may provide important insights to others working across the world to develop and improve health systems.

The U.S. experience provides lessons from the organization of healthcare delivery systems to insights about details of clinical service delivery.  There are also a growing number of delivery systems that have expanded beyond the traditional medical care paradigm to focus on improving population health. Recent advances in care coordination, team structure and function, application of innovative health information technology solutions, and patient engagement in governance and quality improvement have resulted in significant improvements in health outcomes in these systems. 

The Bill & Melinda Gates Foundation recognized that primary care in the U.S. could be a source of lessons and tools to inform the Primary Health Care Performance Initiative partnership, and commissioned Qualis Health to convene a symposium on the topic at the Foundation’s Seattle headquarters on November 9, 2016.

Throughout the day, experts from exemplary organizations introduced U.S. models of primary care delivery system design, followed by a reactor panel of global health experts reflecting on how the models and concepts presented could be of interest to those working to strengthen health systems in LIMCs. We hope the Symposium Proceedings and videos will provide ideas and inspiration for policy makers and implementers across the globe as they strive to improve care for the populations they serve.

1. Symposium Welcome and Overview
Jonathan Sugarman, MD, MPH, Qualis Health and Dan Kress, Bill & Melinda Gates Foundation

2. Community-Based Primary Care at Southcentral Foundation
Donna Galbreath, MD, Southcentral Foundation

3. America’s Federally Qualified Health Center (FQHC) Program: Comprehensive Primary Care for Underserved Populations
David Stevens, MD, FAAFP, Milken Institute School of Public Health, The George Washington University

4. The Front Lines of Primary Care: A Case Study of an Exemplary Federally Qualified Health Center (FQHC)
Margaret Flinter, PhD, APRN, Community Health Center, Inc., The Weitzman Institute

5. Transforming Primary Care in a Community-Based, Academically Affiliated System: Cambridge Health Alliance
Soma Stout, MD, MS, Institute for Healthcare Improvement

6. The Medical Home Model and Population Health Management in a Large, Vertically Integrated Health System
Wellesley Chapman, MD, Group Health Cooperative

7. Sharing Specialty Expertise to Enhance Primary Care, Project ECHO
Sanjeev Arora, MD, University of New Mexico; Project ECHO Assuring Lifelong Learning


8. Assuring Lifelong Learning and Assessing Primary Care Physician Competence
Robert Phillips, MD, MSPH, American Board of Family Medicine

9. Disruptive Innovations in U.S. Primary Care

  1. Part I: Overview
    Andy Ellner, MD, MSC, Harvard Medical School Center for Primary Care
  2. Part II: A Digital Health Example
    Sean Duffy, Omada Health

10. Financing Advanced Primary Care
Asaf Bitton, MD, MPH, Ariadne Labs

11. Innovations in Delivery System Design: Technology and Beyond
Carroll Haymon, MD, Iora Health

12. Reactor Panel, Bridging the U.S. Experience to the Realities of Low- and Middle-Income Countries
Rashad Massoud, MD, MPH, University Research Co., LLC
Cheryl Scott, McClintock Scott Group
Susna De, MPH, MSc, Bill & Melinda Gates Foundation
Hong Wang, MD, PhD, Bill & Melinda Gates Foundation

13. Closing Remarks
Jonathan Sugarman, MD, MPH, Qualis Health


Jonathan Sugarman, MD, MPH, is President and CEO of Qualis Health, a Seattle-based nonprofit and U.S. national leader in improving population health.