Activities

Update

1. Implement priority initiatives related to quality, patient satisfaction and productivity.

• Continue to coordinate Choosing Wisely Canada (CWC) activity in Alberta.
• Support development of local clinical pathways (e.g., the Canterbury initiative).

The Amending Agreement provides for the establishment of the Appropriateness and Evidence-Based Improvements Committee to advise the Management Committee on issues and opportunities related to improvement of health care system delivery. The committee is in the process of gathering information from each of the participating organizations as to individual projects relating to appropriateness and quality. Following this, the committee will focus on additional pilot projects towards system appropriateness.

2. Update PCN operational supports:

• Seek sustainable funding for primary care panel work which includes both the development of process improvement tools and train-the-trainer dissemination.
• Improve the way we support PCNs to move towards standardized service offering and improved governance, management and accountability.
• Develop a Chronic Disease Management (CDM) support service for PCNs to improve their support to member clinics in the implementation of Patient’s Medical Home.
• Improve integration of these services with AH and AHS partners.

Unused Continuing Medical Education funds of roughly $4.5 million were made available to sustain panel work and support other agreement delivery activity including integration of care initiatives, Chronic Disease Management, Central Patient Attachment Registry and blended capitation model, through to March 31, 2018.

A revised PCN governance structure was ratified and implemented under the PCN Framework. Work to implement the zonal governance structures and further initiatives within the framework continue.

In support of achieving a key element of the Patient Centered Medical Home AHS/AMA/HQCA have launched a joint Chronic Disease Care Planning (PaCT) Initiative. PCN Innovation hubs are currently being implemented.

See integrated care delivery strategy under activity 3.

3. Begin the development of concepts and services to support partnerships between primary and specialty/acute to improve the care of patients transitioning between services and work in partnership with AHS in the development and piloting of these services.

• Work with AH and AHS to develop an integrated care delivery strategy and supports required for integration.

Under the Amending Agreement, the AMA, AH and AHS, have agreed to work towards an integrated care delivery strategy. AMA program staff are working within Primary Health Care Integration Network to work across the province on integrated care projects with the intent to scale and spread successful solutions.

Alberta Health has committed to both a provider and patient attachment registry. The Central Patient Attachment Registry is expected by December 2017.

The specialty care coalition which was recently formed within the AMA will serve as an important vehicle to forward partnerships between primary and specialty care.

Activities

Update

1. Alignment of physician compensation activities with system objectives:

• Assist section to identify SOMB rule changes to support section budget management responsibilities.

Under the AMA Agreement, the parties agreed to a process for identifying $100 million in SOMB savings. The project was successful in reaching its goal of a projected $100 million dollars in savings. The actual impact of these changes will be determined by the reconciliation committee.

The March RF considered and provided direction on other key compensation matters including:

• Income equity
• Section budget accountability

The PCC has contracted Deloitte LLP to conduct an overhead cost study. Consultation with sections begins in September 2017. The project is expected to wind up in July 2018.

Along with a renewed set of Provincial Strategic Requirements, the PCC will deal with matters of physician compensation along with the following priorities:

• Update the physician business cost model
• Implement an S-INRV methodology
• Implement an inter-sectional relative value methodology
• Allocation 2017 (subject to reconciliation process)
• Consider second round of individual fee review

Participate in provincial physician human resource planning:

• Ensure that physician supply is reasonable to meet Alberta population health needs including needs by specialty and by geographic location.
• Ensure that physician expenditures are rising appropriately with the effect of growing numbers of physicians well understood and reliably measured.
• Ensure that services more appropriately administered by physicians continue to be physician delivered.

Under the Amending Agreement, AMA and AH have agreed to the development of a needs based physician resource plan. Regulations have been implemented by government that establishes a Physician Resource Planning Advisory Committee. The AMA was provided two representatives on that committee.

The AMA has established an ad-hoc committee to support its representatives and to provide advice to the AMA Board on issues related to Physician Resource Planning. The committee will meet quarterly.

The AMA will be developing a member engagement strategy to seek member input and feedback on physician resource issues. The issue of physician resource planning will be a significant topic in Negotiations 2018.

New Activities
The Amending Agreement includes the implementation of a Blended Capitation Model for primary care. One clinic is live with Blended Capitation Model. Phase two is open for applications and will close September 30, 2017. An evaluation framework will be used to study the success of this initial group. AMA change management and improvement staff are supporting the pilot groups.

2. Physicians are supported by an integrated health information system, including enhanced information exchange and data analytics:

• Support activities that enable the flow of high value health information from community-based physicians to populate Netcare.
• Champion the adoption of a common secure messaging standard for Alberta.
• Negotiate an information sharing framework that meets the needs of physicians and enables the appropriate sharing of patient information amongst providers to improve patient care.
• Confirm and consolidate PCN related IM/IT requirements and work with EMR vendors to address those priorities.

One of the priority activities identified by the government is the flow of physician generated, community EMR information into Netcare. AMA representatives are providing advice to government on two specific pilot projects. The first extracts 71 specified data elements from primary care community EMRs for uploading into Netcare and the second involves making reports (e.g., specialist consult reports) from community EMRs available in Netcare.

The AMA is continuing to work with stakeholders to encourage adoption of a common secure messaging standard and network solution.

A new AHS Clinical Information System-related Information Sharing Approach has recently been negotiated between AMA, AHS, CPSA and the Faculties of Medicine. Subject to RF endorsement, it will replace effective January 2018, the existing framework that was negotiated between AMA, AHS and Covenant Health in 2012.

The development of consolidated PCN-related IM/IT requirements will occur under the PCN Framework that was recently ratified.

New Activity
With the advice of experts, the Board will be developing high level, principle-based IM/IT-related policies consistent with the interests, needs and expectations of physicians and patients.

With financial support from Canada Health Infoway, the AMA is offering “peer-to-peer” consultations to primary care physicians and teams to help them use their EMR to support their implementation of the Patient’s Medical Home.

Activities

Update

1. Continue to expand the albertapatients.ca portal and leverage patient feedback in the development of AMA policy development and strategic planning.

4,800 Albertans are registered with albertapatients, which averaged growth of 150-200 members a month in the past year. The panel is large enough now to conduct statistically valid research. Survey participation and retention rates remain very high. We are beginning to explore board strategic issues requiring insight on the public mindset. Primary care, access, continuity of care, attitudes toward informatics and sharing health information have been explored in the last months of the business year. More frequent and focused research is planned for the year ahead.

2. Expand leadership development opportunities for AMA physicians through increased course opportunities.

The AMA provided five one-day course offerings provided by Heather Lamoureux and Elaine Siefert on the Difficult Conversation, Conflict Resolution (CAMBA) and Team Dynamics. These courses have been extremely well received by participating members. In addition, the AMA supported select AMA board members to attend the CMA Leadership Conference. We are offering an in-house PLI course in Calgary on September 22-23 this year. The topic is Strategic Thinking for Results.

3. Support and advocate for improved health care delivery for the aboriginal community. This will involve outreach to aboriginal physicians and First Nations communities, and participation in the Population and Aboriginal Health SCN.

The AMA convened a working group consisting of two Indigenous public members, two Indigenous physicians and two PCN physicians with experience in outreach programs for Indigenous communities. This working group developed a draft policy on Indigenous Health which was approved by the AMA Board at its July meeting. We are now in the process of putting together an Indigenous Health committee to monitor and suggest priorities and actions for carrying out the recommendations within the policy.