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September 2025 - PCPCM – What I need to know…

Discover more about PCPCM Billing/Payment Flow, Access Improvement, Locum coverage and Communicating the Importance of Access to Patients

Session Summary

Session Host: Kris Kasireddy, ACTT Consultant

Guest Presenters: Graham Vance, ACTT Consultant and Jinny Adair, ACTT Consultant

Recommended Resources: 

PCPCM related
Webinars
Practice Facilitation Core Training : 

Registration Deadline: Edmonton – October 1 
Registration - Practice Facilitator Core Training: Comprehensive - Edmonton

Registration Deadline: Calgary – October 2
Registration information - Practice Facilitator Core Training: Comprehensive - Calgary 

Session Highlights & Themes 

Session Objectives:  

  • To provide clarity on the Patient's Medical Home Comprehensive Care Model (PCPCM), including billing, panel payments, and locum arrangements

  • To explore how access improvement strategies can enhance continuity and patient care

  • To introduce the new event management system (vFairs) for future AMA webinars and resources

  • To address common challenges and questions from clinic managers regarding CPAR conflicts and operational workflows 

Themes:

  1. PCPCM Overview & Billing Mechanics - Presented by Graham Vance and Jinny Adair
    • Detailed explanation of billing timelines, payment flows, and panel payment structures
    • Clarified locum billing options under PCPCM and fee-for-service models
    • Emphasis on claim accuracy, PRAC ID usage, and business arrangement fields
  2. Access Improvement & Continuity
    • Importance of relational continuity between patients and providers
    • Strategies to balance supply and demand using panel size, visit rates, and continuity metrics
    • Tools like the Health Quality Alberta Panel Report and AMA’s Access Improvement Toolkit were recommended
  3. Communicating Continuity to Patients
    • Use of continuity posters, scripting, and consistent messaging to educate patients
    • Resources like the CII CPAR Team Toolkit and Relational Continuity Change Package were shared
  4. New Event Management System: vFairs - Presented by Parvathi Nair
    • Overview of features: personalized schedules, chat rooms, resource access, and Zoom integration
    • Launch planned for October 2025, starting with Networks of Practice webinars. 

Key Takeaways

  • PCPCM Billing: Ensure locums meet the 50% paneled patient threshold when billing under PCPCM. Use correct PRAC IDs and business arrangement fields to avoid claim rejections

  • Panel Management: Use data to assess panel size, visit frequency, and continuity. Aim for a slight surplus in appointment supply to avoid delays

  • Access Optimization: Reducing return visit rates can significantly improve accessibility and open capacity for panel growth. Find the balance between clinical outcomes and the least resource-utilization needed

  • Patient Communication: Consistent messaging about continuity improves outcomes. Use AMA resources to support this effort

  • vFairs Transition: Prepare for the new platform by activating AMA profiles. Training and support will be available.  

Practical Tips for Clinic Managers

  1. Pre-booking Strategy for Locums: Group paneled patients in the morning and non-paneled in the afternoon to meet PCPCM billing requirements
  2. Panel Size Calculation: Use weekly appointment counts and subtract vacation/stat holidays to estimate annual supply
  3. Conflict Resolution: Monitor CPAR reports monthly and contact AMA’s CII CPAR team for persistent issues
  4. Continuity Messaging: Start small with scripting trials and refine based on patient feedback
  5. vFairs Onboarding: Ensure staff have AMA accounts and familiarize them with the new platform’s features. 
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