The following roadmap outlines what is needed at each phase to build the model—your model. The essential work is to establish the core competency, engage the right people, and create the structures that will support the intended outcome. Each phase lays the foundation for the next, gradually turning a shared vision into a durable cooperative primary care model.
The six phases provide the general path for building the model. That sequence holds whether the work begins with a community, an employer, a health system, or an entire region.
The specific plan emerges on the ground. It depends on who is ready to lead, what capacity already exists, which resources can be brought together, and what the local environment will allow. Those conditions determine the pace and shape of the work.
The roadmap remains consistent. The route and the timeline belong to the place doing the work.
The six phases
The first three phases build the foundation. This is also where efforts like this often die quietly, preserved in a business plan that no one seriously pressure tested. The mistake is assuming, “We have seen this before,” instead of asking, “What must we look at differently this time?”
The final three phases turn preparation into build out. This is where the model moves off the page and becomes a functioning clinical resource.
The horizon
The institutional and policy conversation is deliberately kept outside the six phases rather than made a phase of its own. It begins only after the model has substance behind it. Each failed effort documented in The Record reached for legislation or a ballot before it had demonstrated the care model in practice, then entered its decisive argument asking the public to trust what did not yet exist.
This framework reaches that conversation last. By then, it should carry a functioning clinical model, a tested fee strategy, committed anchors, meaningful measurement, and a multi-site record of care delivered over time. The request is no longer permission to exist. It is partnership, support, and room to continue what has already been shown to work.
The timing of a specific project belongs to the people and places building it. It does not belong to this page. Every effort in The Record carried a projected date into its decisive moment, and each became more difficult to defend when that date passed without the promised result. The six phases are structured as the clinical arc is structured: around a defined endpoint, not a deadline.
This roadmap does not assign a date to any single phase, because the pace of a specific project depends on circumstances this page cannot see. The framework itself does have a working horizon. By 2028 — the fiftieth anniversary of the Alma-Ata Declaration — the full model mapped above will be operating at scale: a cooperative running the complete clinical and delivery system described here, working in practice rather than existing only as a pilot or proposal. More than twenty years of work already stand behind this framework. What remains is building the model itself, and that work is underway now.
By 2038 — the sixtieth anniversary — the goal is for the model to have moved beyond its first working environment and to be adapted and adopted by communities elsewhere. These dates are not deadlines imposed on the six phases. They are goalposts for the work: 2028 for making the model real at scale, 2038 for carrying what works outward.