Organizing Delivery Systems to Better Support Primary Care: What Can States in the US Learn From and Share With Australia?

Walkabout Medical Homes with Mary Takach: A 10-month Study of Australia
September 2014

What can states with large frontier areas such as Alaska, Texas, Montana, and Arizona learn from how Australia organizes and supports primary care delivery in its vast outback? 

What do publicly financed community-based teams, networks, and organizations found in states including Vermont, North Carolina, Oregon, and Colorado have in common with the Australia government’s four-year experiment in financing and organizing local primary health care organizations nation-wide?

What lessons can states such as Massachusetts, Rhode Island, and Pennsylvania share with the Australian government on how to evolve primary care provider payments from fee for service (FFS) (yes, Australia general practitioners also get paid FFS) to blended payment models that include capitation and shared savings to better support access to medical homes?

These are just a few of the questions that I am seeking to answer and share with you as I pursue a remarkable 10-month fellowship opportunity offered by The Commonwealth of Australia Department of Health and Ageing and The Commonwealth Fund. As the 2014-2015 Australian-American fellow, I will be conducting a comparative analysis of the roles of publicly financed, primary health care organizations in Australia (Medicare Locals) and in the United States (found in states including Colorado, Oregon, North Carolina and Vermont). The study will compare their similarities and differences as well as identify innovative, forward thinking strategies of a select number of these locally based organizations in supporting primary care providers to become high functioning medical homes.

I have the pleasure and honor of working with Claire Jackson, Professor in General Practice & Primary Care at the University of Queensland in Brisbane and the Clinical Director of the Centres for Primary Care Reform Research Excellence that explores new models of integrated care between hospital and the community. 

With both countries deep in health care delivery reform flux, there is a great deal that we can learn and share from each other. Leading states within the US are accustomed to looking across state lines to learn from each other—looking across the Pacific at the delivery system reforms underway in Australia will bring a new perspective to state work. 

Rather than wait for my research to be published next year, I will distill the lessons that I learn along the way in Australia in a monthly blog making them relevant and timely for the work ongoing in the states. This, of course, is the essence of NASHP’s mission of supporting excellence in state policymaking.

I will also strive to bring cultural enlightenment to blog readers who stick with me over the next 10 months answering such questions as, “What is vegemite and is it a better spread than peanut butter?” 

Please feel free to post on the blog or email me directly at You can also follow me on Twitter @MaryTakach.

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