The tree is universal. The cultivation belongs to those who plant it.
This site presents a framework. It does not claim to know what that framework looks like where you are.
The principles here were developed through more than twenty years of research and integrative practice in one place, by people who know that place. We share them because we believe they point toward something real and replicable. What replication looks like in your community, your culture, your resource environment — that is work only you can do.
The Clinical Framework
Sixteen primers. Start anywhere. Read in sequence or follow the thread that matters to you.
Why this framework exists
The execution gap, the Alma-Ata promise, historical clinical lineages as evidence, and the two algorithms that govern clinical reasoning. Five primers that establish the diagnosis before presenting the model.
Three pillars: strategy, integration, trust
Isolated care, inclusive care, and true integrative care. The arc from presenting condition to full recovery. Trust as a clinical variable — and the harder, slower trust of institutions, administrators, and outside clinicians, the most consequential trust for adoption at scale.
The instruments every practitioner carries
The stress/diet/sleep triad. The patient capacity pyramid. Constitution as the variable that makes care genuinely personal.
Health agency and clinical confidence
Health agency: the model's highest-order outcome, with observable clinical signs. And the clinical confidence problem — why technically skilled providers still fail patients by optimizing for the presenting instance rather than the full arc of recovery.
- 01 Start here Live
- 02 The Alma-Ata Declaration Live
- 03 The execution gap Live
- 04 On historical medicine Live
- 05 The two algorithms Live
- 06 Three models of care Live
- 07 The hub — structural support for a dynamic model Live
- 08 The arc of care Live
- 09 Validation and the wandering problem Live
- 10 Trust as a clinical variable Live
- 11 Trust for administrators, clinicians, and NGOs Live
- 12 Stress, diet, sleep — the triad Live
- 13 The patient capacity pyramid Live
- 14 Constitution — knowing the individual Live
- 15 Health agency — the Stage 3 target Live
- 16 The clinical confidence problem Live
The Cooperative Model
The delivery structure that makes the clinical framework sustainable.
Why a cooperative
The structural argument for community ownership. What the insurance model gets wrong and why removing it from primary care changes everything.
How it works
Membership, the integrated care team, what most people need in a given year, and the four-tier payment structure that keeps care accessible.
The federated backbone
How local cooperatives connect through shared infrastructure without losing what makes them local. The principle that makes the model scalable.
How to get involved
Three doors: as a member, as a practitioner, as a community builder. The model is open. The invitation is genuine.
The Roadmap
Six phases from one clinic to a federated network. Real mechanics of each phase to make it happen.
Worked Examples
What we know, because we built it — at two scales.
The model as a practice
More than twenty years of research and integrative practice in Minnesota. The hub model in practice, the patient population it serves, and what the arc of care looks like when it is held consistently over time. Presented as one application — not the application.
The model case by case
How the model reasons in practice — and how care goes wrong when it does not. Real clinical cases, embellished for teaching, each walking through the decision points where recovery is won or lost. Every case links back to the framework principles behind it.
Global Resonances
Places where existing conditions align with parts of this framework. Presented with what we recognize — and honest about what we do not know.
The following are not implementation guides. We do not claim to know what this model looks like in Rwanda, Brazil, or Thailand. We recognize conditions that rhyme with the framework. Local practitioners, communities, and policymakers are the only ones who can know what it actually means where they are.
If you see your community in this work, we want to hear from you.
Rwanda — Mutuelles de Santé
A national community-based health insurance cooperative, grown from a three-district pilot to more than 85% population coverage. The cooperative structure exists. The integrative clinical arc does not yet.
Brazil — the Family Health Strategy
Tens of thousands of fixed-territory family health teams covering 120 million people. The community-embedded team structure maps closely to the integrative model. The arc of care framework is the missing layer.
Thailand — the Universal Coverage Scheme
Coverage extended to the entire remaining uninsured population within about a year, anchored in a flat-fee, later fully free, national scheme. Proof that access can be achieved fast. The integrative clinical depth is the next question.
Uganda — Kisiizi Hospital cooperative insurance
A hospital-anchored cooperative insurance model, organized through community associations, running since 1996. Community ownership and cooperative governance proven in a low-resource setting — at a scale that still has real room to grow.
Reference
Quick-reference pages, primary source documents, and the evidence base behind the framework.
- → The Evidence Base Live
- → Frequently Asked Questions Live
- → Key Terms Live
- → Arc of Care Stages Live
- → Historical Clinical Lineages Live
- → Declaration of Alma-Ata — Full Text Live
- → Declaration of Alma-Ata — PDF ↗ Live