Business Plan and Budget

2018-19

The following outlines the AMA plan for the 2018-19 business year (October 1, 2018 to September 30, 2019).

The plan was developed by senior staff with oversight and approval of the Board of Directors. Its focus is the goals established by the Board which are aimed at delivering value to physicians by remaining true to the AMA Mission (physician leadership and support) and striving to its Vision (a high performing health care system for Albertans). Operational plans, such as the 2018-19 budget and intended improvements to core capacities and capabilities, are also covered.

You may find the major business plan documents to the right in the side-rail or by scrolling to the bottom of this page. The plan documents are as follows:

A. Vision, Mission and Values
As established by the AMA Board of Directors

B. Key Result Areas, Goals and Activities (Ends)
Healthy AMA (Means)
Under the AMA Mission the Board establishes the goals for the organization, which are categorized in three broad Key Result Areas: Financial Health for physicians and their practices; Well Being (personal, workplace, community); System Leadership and Partnership. There are currently nine goals, three under each key result area.

The purpose of the goals are twofold: they express how the Board wants to deliver value to physician members and also what is felt to be most important in moving from the current system to the Vision.

Connected to each goal are the related activities planned for the next twelve months. These are developed by staff with Board oversight. Progress on activities is reviewed and updated over the course of the year.

The above all has to do with ends: what are we doing to deliver value to members. To do this requires that we have the means at our disposal, which is captured under the phrase “Healthy AMA”. The second part of Attachment B deals with what is being done in this regard in the area of governance, finances, knowledge, relationships and workforce.

C. 2018-19 Budget
This provides the 2018-19 budget as well as the 2017-18 budget for comparison. Annual forecasts up to 2023-24 are also provided.

In addition to the budget, the status of all AMA Reserves and Contingencies are reported, as well as the amounts for government-funded programs

These three documents comprise the 2018-19 AMA Business Plan. What follows is more contextual in nature, outlining the major considerations that went into plan development.

Environment

Changing Mandate

Three major changes in the AMA’s mandate will fundamentally impact how the AMA relates to members. These represent both new roles and responsibilities, with new opportunities that the organization will need to assess and make best use of.

Changes in AMA Mandate

  • Recognition:
    Contractual to Legislated
  • PCN Governance:
    Decentralized to Centralized
  • Change Management:
    Unstable/Segmented to Stable/Integrated

One of the most significant of these is the movement from a contractual base for the recognition of AMA by Alberta Health and Alberta Health Services to a legislative base.

This provides greater security for physicians – avoiding some significant challenges that have arisen in other provinces – and reflects recent legal developments regarding rights of representation and freedom of association. It opens up new venues for the AMA to increase its connection to members, notably academic physicians and those physicians that are paid through AHS.

PCN Governance – moving from 42 primary care networks to a local-zone-provincial structure – also opens up new challenges and opportunities. For the system overall, the ability to connect the acute and primary care systems has been greatly enhanced. For the AMA, questions are raised in terms of how best to support and at what level of governance, e.g., zonal vs. provincial.

Finally, the AMA has faced challenges in a past number of years over the stability of several change management programs, such as the PCN Program Management Office and Toward Optimized Practice. The new agreement stabilized these programs through evergreening and also provides the AMA with greater manageability, e.g., the movement of funds between programs to match priorities.

Evolution Within the System

The changes in AMA mandates are taking place in a health system that is itself changing. Three trends will have a significant impact in the upcoming years.

System Evolution

  • Information: Disaggregated to Integrated
  • Medical Home to Medical Neighborhood
  • Financial Uncertainty to Predictability

The trend towards integrated and accessible health information continues. This next twelve months will see in Alberta the introduction of a patient portal, further implementation of EPIC within the acute care system and advances in Connect Care. Increasingly, physicians will have to operate within and participate in a connected health information environment.

With PCN Governance in place, new payment models being developed and integrated information systems, Alberta is now poised to advance from the medical home to the medical neighborhood, i.e., moving from primary care to the entire health system. Future challenges and opportunities relate to the alignment of operations, funding flows, financial incentives and responsibility for the sharing and use of information.

This past year has been marked by fiscal constraint. Concerns over sustainability and value for money will continue, especially in a time where overall challenges within the Alberta economy and the size of the provincial debt continue. Attempts to squeeze compensation will continue as will efforts to pass risk for financial overruns from payers to providers. With physician practices already strained, significant effort will be required to educate payers and the public on the value brought by and the need to sustain physician practices.

Arising Issues

The last 12 months have also seen some arising issues that the Board wants more attention paid to.

New Priorities

  • Healthy Workplace
    • Respect
    • Equity
    • Leadership
    • Wellness
    • Inclusiveness
  • Member Engagement

One of these has been labelled under the broad concept of “healthy workplaces”. This pulls in concepts such as respect, equity, leadership, wellness and inclusiveness. Additional scoping and definition will be required as the board works through this issue.

Member engagement is key to any association. With all the challenges facing members – practice viability, heavy workloads, changing health environments – the Board wants to ensure that member concerns can be heard and responded to. While the AMA does not control many of the factors impacting physicians, it needs to remain the place where the discussion can occur and effective action formulated and acted upon.

Relationships

The AMA’s relationship with AHS will also need to evolve as a result of a number of issues, some of which have already been raised. This includes: heavy investment in information technology; changing nature of representation, as reflected in the Strategic Agreement; movement to greater zonal authority in some operational areas; PCN Governance and integration.

Relationships

  • Government
  • Alberta Health Services
  • Canadian Medical Association

Finally, the CMA is undergoing a renaissance due to sale of MD Management and new strategic priorities. The AMA-CMA relationship will need to evolve in the best overall interest of Alberta’s physicians.

What’s New for 2018-19

While developed annually, each AMA business plan spans several years. The Key Result Areas and goals, for example, are long-term in nature and reflect how the association strives to deliver value. The associated activities, while focused on the upcoming twelve months, also often have a longer time frame.

This past year, however, has seen a great deal of change. As a result, the 2018-19 business plan reflects more than its fair share of adjustment in activities and this next section reports on the most significant of these. Major changes for 2018-19 are summarized the table below.

AMA Business Plan: What’s New for 2018-19

  • New Goal: Healthy Workplaces
  • Improve Information Base
    • Strategic Insight
    • Understanding Members (information base; communication)
  • Integrate Change Management Programs into Business Plan
  • Operational Review
    • Representation/Negotiations
    • Change Management Programs
    • Information Management and Technology
  • Complete all Major Elements of Income Equity Project: To Be Submitted to Members
  • Relationships
    • CMA
    • Government
  • Internal AMA Leadership
    • Additional RF time
    • Specialty Care Alliance

The first major change listed is a new goal under the Key Result Area of Well Being:

“The AMA is committed to working with and for physicians to address system issues which impede attaining a safe, healthy equitable working environment.”

The AMA has had long-standing goals related to the well-being of individual physicians and the communities they serve. The new goal reflects a number of issues that are receiving increased attention, including those of gender pay equity, implicit bias, #MeToo medicine, inclusiveness and diversity. There are several opportunities that the AMA can align to in order to advance healthy workplaces: the AHS leadership strategy and the soon-to-be released report on gender equity; the CMA’s interest in diversity and inclusiveness and its strategy to increase its direct member engagement; the CPSA’s leadership strategy, which includes the concept of healthy workplaces.

Early work on the new goal includes a workshop with interested members and a meeting scheduled with other stakeholder organizations: CPSA, AHS, CMA and the Canadian Medical Protective Association. The Board will also be doing work early in the year to identify what the key issues are, how bests the AMA can influence these issues, who we have to work with and what resources are available.

Making the right decisions in a complex and changing environment has a lot to do with being able to gather and assess important information. In very broad terms, this information is of two types:

  • Scanning (Current State): What is going on today. What, for example, is the view of Albertans on information sharing, the current financial status of physician practices, the present economic and political circumstances.
  • Ongoing Strategic Dialogue (Strategic Insight): The direction of things. Which of these can be influenced and which are more inexorable?

The AMA has been making inroads on scanning the current state and will continue to do this over 2018-19. In addition, the Board has committed to a new process and additional resources to generating strategic insight. An example of the latter is the hiring of a Chief Strategy Officer in 2018.

The key source of information for AMA comes from its physician members. Early in 2018 an audit of our communications strategy was carried out and the implementation of its key recommendations will take place over 2018-19.

The relationship of the AMA’s information strategy to its Vision, Mission and goals is illustrated in this diagram: (Click to view full size)

Another change for this year is the integration of the AMA change management programs into the overall AMA business plan. Previously these were kept separate, but with the recent enhancements in stability and manageability mentioned earlier this is an opportune time to incorporate the programs into the AMA business plan.

The new environment also requires AMA staff to consider how the work is getting done, i.e., an operational review. This is especially so in three important areas:

  • Recognition and representation
  • Change management services as supported through several government-funded programs
  • Information management and technology

Work has commenced in each of these areas, including the assignment of senior staff. The general issues being raised are as follows:

  • Immediate demands and requirements, especially over the next six months
  • The strategic opportunities that have been created and support for the Board and RF in assessing these opportunities
  • Longer term core competencies and capabilities, including an assessment of current organizational structures and how these can be improved.

the goal this year will be to complete the technical work and get this into the hands of the Board and RF. This appropriately leaves the question of what to do with the study with these governing bodies. Following that, the Board and RF have already determined that there will be a member referendum.Relationships with other organizations are fundamental to the AMA being able to advance physician interests, including their interest in a quality, patient-centered system. Opportunities related to partnership regarding healthy workplaces have already been mentioned. Relationships with at least two organizations will likely be going through fundamental renewal in 2019.

First, this year has seen the CMA considering new governance models and also moving forward on their strategic plan. The ability to deliver on their plan has been significantly enhanced by the recent sale of MD Management. Over the course of the next year, AMA and CMA will have to consider the opportunities this presents and what relationship the two organizations want to establish to best serve Alberta’s physicians. Some preliminary discussions have already begun.

Second, there will be a provincial election in 2019 which, regardless of outcome, will have an impact on our relationship with government. The Board has been developing a strategy to inform all standing MLAs and all parties as to issues facing the profession and the system.

Finally, additional leadership support and input will be required. The expanded budget and time for RF is an example of this. Support for the Specialty Care Alliance – which arose last year and has already started working with Primary Care – has also been included.

This concludes the overview of environment and related adjustments to this year’s business plan. Additional details are contained in the attachments A to C as previously described.

You may view the major business plan documents via the links below.

Vision and Mission

Learn about our vision and mission. Alberta's physicians are committed to a health care system that facilitates wellness and delivers patient-and family-centered care.

Key Result Area 1

The AMA assists and supports members in maintaining their financial health. This includes negotiating with payers to ensure fair compensation, the provision of practice management services and the offering of financial products. Members in training are supported through a number of scholarships and bursaries.

Key Result Area 2

The AMA supports members in maintaining healthy work-life integration, including being a leader in the development of a comprehensive physician health program. The AMA promotes and supports physicians contributing to the broader community through activities like the AMA Youth Run Club and Emerging Leaders in Health Promotion grant program. The AMA also supports physicians in their efforts to attain safe, healthy and equitable work environments.

Key Result Area 3

The AMA supports members in their role as leaders within the health care system. This includes supporting physician leadership in developing innovations in care delivery and integration of primary and specialty care. Other activities include the AMA’s key role, with Alberta Health through the AMA Agreement, in developing and implementing the physician payment strategy for the province; several programs aimed at quality improvement; activities related to eHealth; and supporting the development of physician leadership skills.

A Healthy AMA and 2018-19 Operating Budget

Achieving the goals under the three Key Results Areas requires a healthy, vibrant and sustainable AMA. View Healthy AMA activities and the AMA 2018-19 operating budget.

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.