SLIDE 1
Primary Care Networks in Alberta
National Healthcare Leadership Conference
Saskatoon, Saskatchewan June 2, 2008
SLIDE 2 Presentation
1.
Overview of Primary Care Initiative
Betty Jeffers
2.
Alberta Health & Wellness Perspective
Betty Jeffers
3.
Regional Health Authority Perspective
Marion Relf
4.
Alberta Medical Association Perspective
5.
Common Viewpoints
6.
Question and Answer
SLIDE 3 What is Alberta’s Primary Care Initiative?
Strategic agreement under the 8 year tripartite Master
Agreement between Alberta Health and Wellness (AHW), Regional Health Authorities (RHAs), and the Alberta Medical Association (AMA)
Provincial framework to improve access to and
effectiveness of primary care services
Collaborative, comprehensive, and cooperative
approach
SLIDE 4 Master Committee Secretariat
Physician Services Agreement Physician Office System Program Agreement Primary Care Initiative Agreement Physician On-Call Programs Agreement
PS Committee POSP Committee PCI Committee POCP Committee
Agreement Structure
SLIDE 5 Primary Care Initiative Committee
One of a number of Strategic Physician Advisory
Committees
Mandate is to provide oversight for implementation of
the Primary Care Initiative
Broad responsibilities include all aspects of
implementation, provincial policy direction, recommendations on funding, monitoring and evaluation
Equal representation from the partners (AHW, AMA
and RHAs) and consensus decision-making model
AHW retains funding responsibilities
SLIDE 6 Primary Care Networks (PCN)
New way to deliver primary care Local initiatives within provincial framework Formal arrangements between an RHA and a group of
physicians
Defined roles and responsibilities RHA and physicians in PCN jointly:
– Make decisions – Provide service responsibilities – Receive payments
SLIDE 7 PCN Funding
Mixed funding environment Physicians bring existing payment arrangements into the
partnership – either fee for service or alternate compensation plans
Networks receive funding of $50 per capita for each enrollee –
- nly informal enrollment is currently being used
Informal enrollees are identified through historic encounters with
participating physicians
New method to define these enrollees through assignment to
patient panels is being implemented
Funding may be used to implement programs as per approved
business plans – including administrative and overhead costs, staffing costs and so forth
SLIDE 8 PCN Governance
PCN partnership is formed through a joint venture
agreement between the RHA and a not for profit corporation (NPC) formed by the physicians
Physicians sign this agreement and related letters of
participation; RHA signs the agreement
Partnership forms a governance committee to provide
Day to day operations are typically managed by the
NPC but many arrangements in place
SLIDE 9 Primary Care Initiative: Provincial Objectives
Increase the number of Albertans with ready access to
primary care
Manage 24/7 access to appropriate care Increase emphasis on:
– Health promotion and disease and injury prevention – Care for patients with chronic diseases, complex problems
Better coordination and integration between
components of the health system
Greater use of multi-disciplinary teams
SLIDE 10 Alberta Health and Wellness Perspective
Betty Jeffers
Director Primary Care Unit Alberta Health and Wellness
SLIDE 11 Government Role
Alberta Health and Wellness Roles:
1)
One of three partners to the agreement
2)
Provide funding and manage related accountabilities
3)
Overall health system policy direction
4)
Integration with other government policy directions
5)
Dissemination of best practice
SLIDE 12 “Partnership” Role
Provincial Partnership
–
Equal representation on tripartite committees
–
PCIC oversight and provincial policy framework
–
Consensus model (not traditional government role) Local Partnership
–
RHA/Physician based
–
More traditional perspective on government role at this level
SLIDE 13 Funding and Accountability Ensuring that accountability framework meets AHW requirements as funder
AHW accountable to public for funding and related
service delivery
Establishing internal controls related to this Negotiating appropriate reporting and monitoring –
consistent with government reporting requirements
Developing operational interface with other
- perational support structures
SLIDE 14 Health System Policy
Ensuring that implementation of the initiative is
consistent with overall health system policy directions
Coordinating implementation with other government
initiatives and major activities (examples – access strategies, public health strategy, continuing care)
Developing policy positions for AHW participation in
PCIC policy development process
SLIDE 15 Dissemination
Best Practice
Dissemination of other related activities, for example, Primary
Health Care Transition Fund
Supporting Success
Provision of additional resources (ranging from funding for
resource development such as team training manuals, to support for access to practice improvement resources)
SLIDE 16
Benefits of Governance Approach
Local Flexibility leads to true innovation Responsiveness Consensus model creates a new type of
partnership (not an “in the box” approach)
Participatory Approach leads to better “buy-in” Enables joint design and implementation (not
imposed)
Promotes better integration of publicly funded
health services
SLIDE 17
Challenges
Balancing local flexibility with provincial policy
requirements (provincial policy issues such as universality and access <> local responsiveness)
Recognition of unique roles (“equal but
different”)
Pursuing the common interest without
prejudice
SLIDE 18 Regional Health Authority Perspective
Marion Relf, RN, MHSA
Director Primary Care Initiatives Capital Health – Edmonton Interim Director Program Management Office Primary Care Initiative
SLIDE 19 The Contribution of Alberta’s RHAs
Three roles for Regional Health Authorities (RHAs) in supporting Alberta’s Primary Care Initiative
1)
One of the three signatories to the agreement; responsible for the oversight of the Initiative through representation on PCIC
2)
Contribute to leadership in implementation of the agreement across and through all communities
3)
At a local level, the RHA is a “partner” with a group of family physicians to form a Primary Care Network (PCN) through a legal agreement and joint business plan; varying models – governance/management responsibilities
SLIDE 20 RHA Role in a PCN
The Physician group (NPC) and the Region agree to work together:
Prepare “Letter of Intent” (LOI) Upon LOI approval, by the Provincial Committee, jointly
develop a “Business Plan”
Complete legal documentation Upon approval, by the Provincial Committee, implement a
PCN
Joint governance of the PCN; some management roles
depending on legal model
SLIDE 21 RHA Role in a PCN (continued)
Why did the Initiative set a structure in place that includes the Region and Physician?
Same patients access services of both; Primary Care’s strengths and weaknesses impact the system
as a whole and general health of the current population;
Identifies and fills legitimate gaps, not duplicating services
already provided;
Primary care is the gateway to an integrated health system.
SLIDE 22 Benefits to the Region
Improvements to the health of the population; Ability to match the region’s services more effectively to patient
and physician needs (and vice versa), example – Home Care;
Mechanism to consider and address unmet primary care
needs identified by the Region, for example – Unattached patients;
Re-establishing relationships with family physicians often leads
to new ideas and opportunities.
SLIDE 23 Governance Strengths of the PCI Model
Local PCN Governance
Region and Physicians have equal say and decisions are
made by consensus;
Builds the relationship between physicians and region.
PCI Committee Governance
All three parties are represented and decisions are made by
consensus;
Tripartite structure allows for resolution at more senior levels
when required.
SLIDE 24 Governance Challenges
Local PCN Governance
When relationships are strong and positive, it works well; when
they are not the governance model may not provide options.
PCI Committee Governance
Always three parties and their interests to balance; Challenge to set aside the individual parties’ interest for the
program’s best interest.
SLIDE 25 Alberta Medical Association Perspective
G.D. Prince, BMSc, MD, FCCFP, FAAFP
Alberta Medical Association Co-Chair on Primary Care Initiative Committee
SLIDE 26 The Role of the Alberta Medical Association
1)
One of the three signatories to the 2003 agreement.
2)
Provide Logistical support to physician and physician groups wishing to develop a Primary Care Network (PCN) through the Practice Management Program
SLIDE 27
The Role of the Alberta Medical Association
(cont’d) 3) Fund Holder for Program Management funds 4) Contribute Leadership to all levels of the Tripartite agreement
SLIDE 28 The Role of the Alberta Medical Association
Practice Management Program
- Assist physicians in managing practice risks
associated with entering PCNs.
- Support physicians as they work through the process
to develop PCNs.
- Support physicians in making informed decisions.
- Assist physicians to realize the full benefits of PCNs.
- Increase PCN implementation success.
- Integrate PMP with the broader Primary Care
Initiative (PCI) framework
SLIDE 29
Individual Physician Role
Individuals and groups of Physicians form an entity (usually a Not for Profit Corporation) to enter an agreement with the Region to form a Primary Care Network. Identify community and physician needs and help build a program to address them. Take an active role in Joint governance of the PCN.
SLIDE 30
Individual Physician Role
Participate in PCN activities
Office Programs Regional Programs Specialty Linkages
SLIDE 31 Individual Physician Role
Why Bother?
Altruism - Desire to improve patient care Supports enhanced office-based delivery of care Physician remains core member of team Part of the design, not a “victim” of the design
SLIDE 32 Benefits for Physicians
Closer, more cooperative relationship with Region. Expanded Capacity to provide care without losing touch with
patients
Financial incentive to provide needed services not traditionally
funded
Improved linkage and communication between community
physicians
SLIDE 33 Why a Partnership? Local Primary Care Network level
Neither Region nor Physicians can coerce the other party to
participate.
For either to receive benefit, both must agree on process. Local solutions developed by local innovation.
SLIDE 34 Why a Partnership? Tripartite PCI Committee Governance
All three parties are interested in success; Demands of the program foster cooperative development of
solutions;
No time to stand on positions
PCIC (and other SPACs) expected to model
cooperative behavior! (How to play nice and get things done)
SLIDE 35 Challenges
Demand has often outstripped support
LOI Application process Business planning Program review Total funding
Impossible to develop policies as fast as Local Networks
propose new ideas!
Have developed a “common law” approach. Use principles to guide
practical solutions
Universality
Recognition that to meet local needs, everyone will not be
the same
SLIDE 36
Conclusions
SLIDE 37 Strengths as Viewed by All
Relationships Improved
–
AHW, AMA, RHA
–
local level
Between physicians Between physicians and region
Buy In has been outstanding and enthusiasm is high Integration of primary care within whole health system is
progressing
Value realized
–
For system
–
For each party
–
For the providers and patients
SLIDE 38
Challenges as Viewed by All
Balancing interest of party with interests of the
initiative
(i.e., patient care, health of population)
Balancing innovation with provincial objectives
and direction
(i.e., local versus provincial)
SLIDE 39 Where are we at?
Program is well established Physician/RHA relationships firm and improving Innovative service delivery happening Widespread enthusiasm, collaboration and buy-in as
PCN partners and physicians establish PCNs
Canada-wide interest Growth of teamwork and collaboration Positive feedback from operating PCNs
