Primary Care Networks in Alberta National Healthcare Leadership Conference Saskatoon, Saskatchewan June 2, 2008
Presentation Overview of Primary Care Initiative 1. Betty Jeffers Alberta Health & Wellness Perspective 2. Betty Jeffers Regional Health Authority Perspective 3. Marion Relf Alberta Medical Association Perspective 4. Dr. Gerry Prince Common Viewpoints 5. Dr. Gerry Prince Question and Answer 6.
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
Agreement Structure Master Committee Secretariat Physician Physician Office Primary Care Physician On-Call Services System Program Initiative Programs Agreement Agreement Agreement Agreement PS Committee POSP Committee PCI Committee POCP Committee
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
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
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 – only 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
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 oversight for the network � Day to day operations are typically managed by the NPC but many arrangements in place
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
Alberta Health and Wellness Perspective Betty Jeffers Director Primary Care Unit Alberta Health and Wellness
Government Role Alberta Health and Wellness Roles: One of three partners to the agreement 1) Provide funding and manage related 2) accountabilities Overall health system policy direction 3) Integration with other government policy directions 4) Dissemination of best practice 5)
“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
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 operational support structures
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
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)
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
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
Regional Health Authority Perspective Marion Relf, RN, MHSA Director Primary Care Initiatives Capital Health – Edmonton Interim Director Program Management Office Primary Care Initiative
The Contribution of Alberta’s RHAs Three roles for Regional Health Authorities (RHAs) in supporting Alberta’s Primary Care Initiative One of the three signatories to the agreement; responsible 1) for the oversight of the Initiative through representation on PCIC Contribute to leadership in implementation of the agreement 2) across and through all communities At a local level, the RHA is a “partner” with a group of family 3) physicians to form a Primary Care Network (PCN) through a legal agreement and joint business plan; varying models – governance/management responsibilities
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
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.
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.
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.
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.
Alberta Medical Association Perspective G.D. Prince, BMSc, MD, FCCFP, FAAFP Alberta Medical Association Co-Chair on Primary Care Initiative Committee
The Role of the Alberta Medical Association One of the three signatories to the 2003 1) agreement. Provide Logistical support to physician and 2) physician groups wishing to develop a Primary Care Network (PCN) through the Practice Management Program
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
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