Activities

Year-end update

1. Continue to strengthen the Patient’s Medical Home for all Albertans:

• Support PCNs to build and deploy to members and clinics an appropriately trained and equipped health transformation workforce (improvement facilitators and physician champions).
• Support members, clinics, and their PCNs to begin the process of improving relationship continuity to patients using CII / CPAR as an enabling tool.

• ACTT continues training and network support for practice facilitators and physician champions, with workshops and follow up support in the field.
• ACTT works with PCN boards and physician leaders to accelerate understanding the value of the health transformation workforce and the transformational support they provide to primary health care and patient’s medical home advancement.
• ACTT is supporting CII/CPAR implementation through project leadership with stakeholders, removing barriers for clinics, supporting implementation by training improvement facilitators and setting up PCNs to support their member clinics to implement.

2. Support activities that integrate care across the system and support the health neighborhood:

• Work with PCA and SCA as well as AHS Primary Health Care Integration Network and PCNs to support members to deploy new provincial solutions for specialist linkage and referral.
• Work with PCA and SCA as well as AHS Primary Health Care Integration Network and PCNs to support early implementation of hospital to home solutions.

• ACTT is supporting PCA in their leadership consultations and recommendations and SCA with a synthesis of evidence for better transitions of care.
• ACTT is providing guidance to AHS Primary Health Care Integration Network with appropriate consultation approaches and partnership role development for Home to Hospital to Home guidelines and implementation.
• ACTT is supporting PCNs with their planning and implementation of current primary care changes to support Home to Hospital to Home processes and behavior changes, as well as new provincial level primary care supports.

  3. Support physician members in their new roles created under the PCN Framework

• Support PCNs in operationalizing new standardized, sustainable and shared services prioritized by the PCN Provincial Committee and PCN Zonal Committees.
• Support physician leaders in PCN zones to achieve functional partnerships with AHS zones to enable new ways of sharing care using sustainable approaches.

• ACTT is supporting PCN physician leaders provincially and at zones to understand the current environment around shared services and also the benefits and risks of implementing the various opportunities for standard shared services.
• ACTT, as a member of the PCN zone support team, supports the PCN zonal committees, specifically the PCN physician leaders. ACTT also continues to work with NPC boards and their partnership with AHS as the joint venture of PCNs.
• ACTT supporting PCN leads executive in renewing the Provincial PCN committee ministerial order to be extended with new and ongoing provincial priorities.

Activities

Year-end update

1. Continue with approved activities in support of the Income Equity Initiative:

• Physician office overhead
  • Approval of overhead policy related to the Model Office
  • Overhead Working Group to finalize a detailed plan to address overhead measurement o Establish a panel of physicians to manage the study
  • Complete field work which may include office visits or other data collection techniques
  • Present preliminary results for validation by the panel
• Hours of Work Study
  • Approval of the hours of work study methodology
  • Establish a panel of physicians to manage the study
  • Complete field work which may include a survey, office visits or other data collection techniques
  • Present preliminary results for validation by the panel • Training and Career Length Study
  • Approve final report
• Market Impact Study
  • Present preliminary report to sections for review
  • Approve final report
• Seek government support for the initiative

• IEI milestones for each of the studies - Overhead, Hours of Work, Training and Career Length and Market Assessment were approved by the AMA Board of Directors in September 2019, and subsequently presented to the Fall 2019 RF. As part of AMA’s annual business planning process, the Board of Directors has identified the completion of the Income Equity Initiative as a priority. There are a number of uncertainties which lie outside of AMA’s control that may affect the timing for completion of the Milestones, including:
  • Government’s unilateral decision to cancel the AMA Master Agreement and the subsequent implementation of the imposed Physician Funding Framework,
  • Potential changes from the Ernst and Young review of Alberta Health Services,
  • The COVID-19 pandemic and its affect on the economy and the economics of physician practice.
• The AMACC is considering timing for IEI data collection (e.g., Hours of Work Study) in relation to indicators that might suggest a return to normal activity (e.g. Phase three re-opening, data-driven evidence such as data sets from AH, resumption of elective procedures and diagnostic tests, and consultation with physician leadership).

Overhead Working Group:

• The OWG developed an overhead measurement policy and approach which was supported by AMACC and presented to Board in February 2020.
• A physician engagement panel has been formed and held initial meetings in mid-February
• The model office approach is informed by data collected from physicians. A physician expert panel is assessing these data and will be grouping physicians with similar costs into reasonably efficient model offices. Costs do not represent an individual physician but rather a similar mix of physicians.
• Layer 1 includes licensing, registration, membership, professional development, and other practice costs common to all physicians.
• A survey to identify the characteristics and costs associated with Layer 2 basic community offices was distributed on March 5 to clinics that volunteered to participate and the Overhead Physician Panel has assessed the preliminary results.
• The Layer 3 Unique Overhead Survey has been provided to sections in order to identify any unique model offices. Physician Panel meetings have been scheduled over the summer and early fall to begin reviewing the survey findings. The number of Layer 3 submissions will determine the number of Physician Panel meetings required in order to review the results.

Hours of Work:

• In December 2019, the Board approved the HoW methodology (an on-line log) and the awarding of a contract to R.A. Malatest & Associates Ltd. to conduct the HoW study.
• The first pilot was completed in March 2020 and feedback received was used to refine the data collection instrument. A second pilot commenced on June 22, 2020 and the contractor, developed a summary of pilot feedback.
• The study was planned to be initiated with members on March 31, 2020. The decision to delay through Spring and Summer as a result of COVID-19 will impact the timelines for this study’s completion, which will also have an impact on the IEI milestones.
• The AMACC will engage an all-section panel in September to discuss return to normal parameters for an opinion on when it is appropriate to proceed with the HoW study.

Training and Career Length

• In September 2019, the AMA Board supported AMACC’s recommendation for the Training and Career Length Modifier, as one component of the ANDI model. The modifier will be looked at again as the results for other studies are collected, and over time as physician training requirements evolve.

Market Impact Study

• The Institute of Health Economics has been contracted by the AMA to perform the Market Impact Study.
• The IHE produced a draft Interim Report on international physician market studies with an emphasis on Canadian literature and data.
• IHE is currently waiting for data from Alberta Health in order to proceed with analysis.

2. Support initiatives that connect Albertans with services (e.g. E-care, schedule modernization, appropriateness management, virtual care, etc.)

• There has been an increase in access and use of virtual care in the community over the past few months.
• MyHealth Records has seen an increase in adoption and continues to plan for further expansion.
• The community EMR vendors expedited development of patient portals, providing more options for patient to physician communications.

3. Support strategic and tactical initiatives that improve informational continuity and enhance information integration and monitor/track the impact of AMA input on evolving discussions and decision making:

• Provide input into the operationalization of key provincial health information-related initiatives, including but not limited to the central patient attachment registry / community information integration (CPAR/CII) initiative, E-delivery of results and the AHS Connect Care provider portal.
• Advocate for and assist where necessary in the development and provision of appropriate transition supports for physicians associated with the changing provincial health information eco-system.
• Provide input into the design and development of a provincial virtual care strategy.
• Liaise with WellDoc Alberta and the PFSP to inform their strategies, given the known impact of workplace systems, processes, and practices on physician wellness. 

• Through a multi stakeholder collaboration, CPSA is leading the development of a Virtual Care Strategy to provide a framework for use and support of Virtual Care by patients and physicians in Alberta. The results of this effort will still rely on prioritization, an up-to-date provincial health information strategy and dedicated resources.
• The AMA has been successful in representing physician interests in changes to community practices, including the eDelivery result process, brought about by the transition to Connect Care and continues to work with AHS to ensure impacts to community physicians are recognized and addressed as the waves progress.
• The AMA has continued to work in partnership with government in advancing the CPAR/CII initiative. Many clinics are now regularly submitting Community Encounter Digests and Consult Reports, as well as receiving eNotifications of specific hospital events. With the three major EMR vendors having been conformed to the specifications, further deployments are expected to begin ramping up.
• The AMA was successful in receiving a onetime grant from AH that will enable development of privacy- related supports for community practices. The project team is in place and work is ramping up.

4. Participate in the development of a needs based physician resource plan:

• Working with the Physician Resource Planning Advisory Committee (PRPAC) develop a better needs-based analysis for community physician requirements.
• Identify any gaps in needed areas and working with the PRPAC develop strategies to meet these service gaps.

• In November 2019, government unilaterally disbanded the Physician Resource Planning Advisory Committee. Following that decision, Bill 21: Ensuring Fiscal Sustainability Act, 2019 achieved Royal Assent on December 5, 2019, with work expected Fall 2020 to develop regulations that would be complete by April 2021 and take effect April 2022. Government has noted that AMA will be involved in reviewing the draft regulations.
• There has been no update provided on the status of the government’s draft regulations; however, we are under the impression that government continues to work on these. One of the biggest issues will be if and how this gets reflected in any new agreement with government. The AMA will continue to work with PARA, medical students, and others to identify issues and coordinate on approaches to deal with those issues.

Activities

Year-end update

1. Leverage the Albertapatients.ca portal to support physician leadership of value, affordability and patient-centered integration.

• Test language and concepts for resonance with patients.
• Apply that learning in order to advocate and promote innovation more effectively.
• Build the experience and reputation of the community among its members by explicitly reporting where and how their input is used by the AMA in our mission and vision activities.
• Maintain steady growth in patient participants.

Albertapatients.ca

• Albertapatients currently has just under 13,000 patients/members, with steady growth around 2,500 new members a year.
• Benchmarking research continues with patient experience in primary care and tracking for specialty care was introduced this year. Over the past year, topics have ranged from childhood vaccination to diagnostic imaging experiences, as well providing unique insights from patients about their health and health needs during the COVID-19 pandemic, including their thoughts related to virtual care and in-office visits during COVID.
• Albertapatients has also been helpful in our ongoing issues with the provincial government. While not directly advocating the AMA’s position through the platform, member notifications provided a very solid base of initial public participation for the PatientsFirst.ca initiative, as well as capturing some timely and valuable information from patients relating to early elements of the Minister’s Physician Funding Framework (most notably comparing patient views on the Minister’s approach vs. AMA’s approach in relation to complex modifiers). The community was able to provide us with a thorough assessment of our #stayhealthyab COVID advertising (which performed very well), as well as leveraging research efforts of other important stakeholders like AHS (Vaping/Smoking cessation study) and HQCA (COVID study).
• Over the next year we’ll be looking to engage albertapatients for their feedback on new provincial initiatives in relation to patient impacts and preferences, and working more closely with the Specialty Care Alliance and the Section of Family Medicine to support their efforts, as well being available to provide timely insights on topics identified by AMA Board and executive.

2. Develop a physician leadership strategy that focuses AMA investment, is aligned with the work of other system partners and encourages system innovation that improves care for Albertans.

• As a result of the COVID-19 pandemic, the AMA was only able to provided three sessions of the eight leadership development courses to the general membership this year. Courses were offered in Edmonton and Calgary. This year’s topics included:
  • Team Dynamics and Communication for Health Care Professionals
  • Walk Your Talk: The Three Levels of Diversity & Inclusion
  • The Spectrum of Behavior in Health Care; Communicating with the High Conflict Personality and Resolving Disruptive Behaviour
  • Errors in Decision Making; why we make the wrong decisions with the “right” facts

3. Support and advocate for improved health care delivery for the indigenous community. This will involve outreach to indigenous physicians and First Nations communities, participation in the Population Aboriginal Health SCN and continued activity of the AMA Indigenous Health committee.

• The Indigenous Health Committee approved work on a series of videos and articles that will focus on Indigenous approaches to health and wellness. The videos and articles will highlight some of the experiences, opportunities and challenges of providing health care in Indigenous communities. These videos/articles will be showcased in upcoming issues of Alberta Doctors’ Digest and other AMA platforms.
• The IHC continues to collaborate with AHS to offer feedback and support in devising ways to increase the uptake of AHS’ Indigenous training course. The IHC also supports the idea of the AMA offering its own Indigenous course as part of its Health Care Leadership series to give greater access to physicians to complete this important training.