An update on strategic agreement discussions

August 21, 2015

Dear Member:

In May I wrote to you about the efforts of the Alberta Medical Association (AMA), Alberta Health (AH) and Alberta Health Services (AHS) to collaborate on initiatives to improve the health care system. These discussions have taken place under the auspices of the existing AMA Agreement, i.e., we have explored ways to augment and modify that agreement in a way agreeable to all parties.

The first phase concludes

Discussion this summer focused on the overall relationship between the parties and ways to improve our joint stewardship and management of health resources. Opportunities to improve were identified, ranging from a bargaining framework covering all payments from AH and AHS, to ways to allocate existing dollars within the system that will improve quality of care for our patients. This included considering three categories:

• Advancing the meaningful use of electronic medical records (EMRs). 
• Promoting appropriateness in the use of health resources through activities like Choosing Wisely Alberta and the local development of clinical pathways.
• Finding ways to align physician compensation with system objectives, such as a voluntary alternative relationship plan for primary care.

The board has overseen these discussions and will continue to do so.

What happens next?

The second phase of discussions has just begun, focusing on the three categories mentioned above. We are looking for specific deliverables that the parties can agree to focus on and support together.

In my mind, the issues of focus and commitment are key. Alberta does not suffer from too few ideas or lack of ability to start new ventures. Rather, we often try to do too much at once and don’t follow through on our execution. The parties share the overall vision of a strong primary care foundation within an integrated health care system, but can we agree on our next steps to get there?

We have been discussing numerous options. I should note that these things are intended to support and build on – not replace – current major activities within the system. Principal amongst these is Primary Care Network Evolution, intended to strengthen primary care within an integrated system. Meaningful use of EMRs, clinical pathways and compensation alignment are all necessary components for progress.

The AMA has very much appreciated the opportunity to work with AH and AHS to explore ways to make more of our relationship and collaborate to improve the system for patients. I think all parties have demonstrated open minds and good intentions.

A vote if required

Any expansion of scope or modification of the existing AMA Agreement would require a ratification vote by physicians. There is still a long way to go and I cannot state with any certainty that there will be a formal package for you to consider in the next few months. I will say that, in my view, we need meaningful change and physicians must be part of leading it.

At the end of the day, when we consider what has been achieved in these discussions, these are some conditions that I believe will determine our success or failure:

• Clear deliverables that provide value to physicians and the system – and some early wins.
• Strong AMA, AH and AHS commitment and sharing of resources.
• Clear mechanisms for the measurement and sharing of any gains.

We will do our best to keep you posted in the weeks and months ahead. As always, your comments are most welcome. Please email president@albertadoctors.org or post a comment below.

Regards,

Richard G.R. Johnston, MD, MBA, FRCPC
President