July 30, 2014, President's Letter

Three priorities for the health care system

July 30, 2014

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Dear Member:

In this letter:

In meetings with political leaders this summer, the Alberta Medical Association (AMA) is communicating three priorities for the health care system:

• Providers as stewards of the system and partners with government.
• Patients as engaged and informed owners of the health care system.
• Integrated care flowing through a medical home for every Albertan.

August is nearly here and I hope you are taking some holidays and enjoying our too-short summer. Here at the AMA, the Board of Directors just completed a two-day meeting and we are planning for the September 19-20 Representative Forum (RF) in Calgary.

In recent weeks we have also taken time to meet with politicians in the province: party leaders and leadership candidates. Some meetings are still being scheduled but we have had some good conversations so far.

We have been talking about our health care system, the AMA’s role and our AMA Agreement with government. We have also pointed out three priorities for making progress in the year ahead. I wanted to share these with you. In the weeks between now and the RF meeting, I will write again, using these three themes as a basis to talk about what’s happening around us.

There is a lot going on. Alberta will soon have a new premier. Alberta Health Services (AHS) has a new CEO and possibly a new board. Within our agreement, the Physician Compensation Committee has begun a review of 20 fee codes that will be our first effort toward modernizing the fee schedule. (PCC Update, July 16). Work is also moving forward in other parts of the agreement. This includes things like how we can implement Choosing Wisely Canada in Alberta and talking about how we can cover the ongoing costs of electronic medical records now that the Physician Office System Program has ended.

These are many other things happening, too. They vary widely, but I think that most relate in some ways to the three priorities I mentioned. I have provided those at the bottom of this letter.

Please review them and then let me know what you think. Comment below or email president@albertadoctors.org.

I will write again soon.

Sincerely,

Allan S. Garbutt, PhD, MD, CCFP
President

Three priorities for Alberta’s health care system

1. Providers as stewards of the system and partners with government

Estimates show that 80% of the costs in health care arise from decisions of physicians and other providers, in the form of infrastructure use and human costs for tests, services, procedures and other kinds of care. Physicians have a professional responsibility to act as faithful stewards of health system resources. We are eager to partner with government to make a better system that is more focused on our patients and their families.

This can only occur when there are healthy relationships between government, physicians and other health providers. The current level of engagement is poor and has been so for some time. Morale among physicians and other providers is very low for a number of reasons. Primarily, people on the front lines don’t feel that they are being heard. All health care providers need to be properly engaged.

Both sides need more than words about making a change. Physicians will partner with government so that we can do things differently. However, we need to see concrete actions and results. For example, most other provinces provide legal recognition that their respective medical associations as the agent of physicians. It would be a positive step to do the same in Alberta.

2. Patients as informed and engaged owners of the health care system

Every health system is talking about patient-centered care. Everyone agrees that patients need to be involved and engaged in their care. Achieving this takes more than talk. Concrete actions are needed.

Patients need appropriate resources in order to be informed partners in their care. Examples include the kind of support that will be available through the medical home, quality of care initiatives like Choosing Wisely Canada and giving patients access to their own personal health information. They need to know the progress of their care and be able to seek further conversation for informed decision making. The data that patients receive must be delivered in a way that is relevant to them.

3. Integrated care flowing through a medical home for every Albertan

Alberta has made a strong start toward a 21st century primary care system. There are 41 primary care networks (PCNs) in which physician-led, multidisciplinary teams are delivering integrated primary care for millions of Albertans. The AMA’s PCN Evolution Framework (which has been incorporated in the Alberta government’s provincial primary care strategy) lays out a plan for making a medical home available for every individual who wants one.

The medical home must exist in a larger neighborhood. It’s not enough to limit our thinking to just primary care. Patients flow from primary to secondary and tertiary care (i.e., surgery, diagnostics and other specialist services) and back again. We need to do a better job of linking that care to primary care. We need to coordinate with government and AHS programs in health promotion and disease prevention, liaise with social services and much more. Continuity and integration at all levels and among all the players will fill the gaps and smooth the patient’s road through the system.