Establish Anchor Participation

The Decision That Makes the Build Real

The first three stages reduce the uncertainty surrounding the project.

Stage One defines what the clinical system must be able to deliver. Stage Two establishes how progress and outcomes will be evaluated. Stage Three determines what the required care will cost and how it can be financed.

By Stage Four, a prospective anchor is no longer being asked to place blind faith in an idea. It can examine the clinical model, outcome structure, resource requirements, and fee strategy and decide whether the project is both sound and achievable.

Stage Four is where an organization makes that decision and steps forward to help lead the first build.

What an Anchor Is

An anchor may be an employer, cooperative, union, public entity, community organization, or another institution responsible for a population whose primary care needs could be addressed more effectively.

The anchor brings a real population, an understood need, practical knowledge, and the willingness to invest in building a better response.

Its participation gives the first build something concrete to organize around:

• a defined group of people;
• known primary care and access needs;
• current healthcare costs and utilization patterns;
• an existing relationship through which participation can be organized;
• and an institution capable of helping move the project from design into operation.

The anchor does more than purchase a finished service. It becomes a founding participant in shaping the first application of the model around a need it already understands.

A Custom First Application

The first build should be designed around the needs of the anchor population.

That may include its geography, workforce, families, access barriers, common health needs, existing benefits, available community resources, and patterns of avoidable cost.

The application can be customized without changing the principles that make the model work.

Trust Built Through the Roadmap

The roadmap is designed to make the anchor's decision responsible.

Before an organization commits to the first build, it should be able to see:

• what care its population would receive;
• how that care would be organized across the arc;
• which clinical and therapeutic resources would be available;
• how progress and outcomes would be evaluated;
• what the model would cost;
• what risks and responsibilities would remain outside the model;
• and what must still be built before operation begins.

This creates a basis for informed trust. The anchor can evaluate the reasoning, challenge the assumptions, examine the remaining risks, and decide whether the opportunity justifies the investment.

The commitment is significant, but it is not speculative. It rests on the clinical, outcome, and financial work completed in the previous stages.

The Work

The initiative will work with prospective anchors to determine where the need, evidence, organizational capacity, and willingness to act come together.

That work will examine:

• the primary care needs of the population;
• current access barriers;
• healthcare spending and utilization patterns;
• areas of preventable escalation;
• the number and geographic concentration of potential members;
• existing benefits and healthcare relationships;
• community resources that could contribute to the model;
• the organization's capacity to communicate with and organize its population;
• the conditions required for participation;
• and the level of investment needed to support the first build.

The clinical and financial models can then be tested against the anchor's actual population and refined where local conditions require it.

What the Anchor Helps Determine

The previous stages provide a substantial foundation. The anchor brings the real-world conditions required to complete the operating design.

Together, the initiative and anchor will determine:

• the population included in the first build;
• the most important needs to address first;
• how members will access the primary care hub;
• which services should be local, shared, or available through telehealth;
• how existing benefits and major-medical insurance will connect to the model;
• how participation will be introduced and supported;
• what the organization will contribute;
• and what evidence will justify continuation and expansion.

The anchor gives the first build its practical starting point. It does not determine the future form of the model for every population or community.

The Required Result

A founding agreement with an anchor organization that defines:

• the population and need around which the first build will be organized;
• the responsibilities of the anchor and the initiative;
• the clinical and operational capacity to be developed;
• the financial commitment required;
• the outcomes and decision points that will guide the work;
• the remaining conditions that must be satisfied before launch;
• and the process for moving from planning into operation.

The Readiness Standard

Stage Four is complete when an anchor organization has examined the clinical, outcome, and financial foundations of the model and made an informed commitment to support the first build.

The anchor population must be sufficiently defined, organized, and supported to give the operating model a credible starting point. The initiative and anchor must also share a clear understanding of what has been established, what remains to be built, and what evidence will guide the next decisions.