Update on discussions with AH and AHS

September 21, 2015

Dear Member:

This is to update you on our discussions with government and Alberta Health Services (AHS).

As I mentioned in my August 21 President’s Letter, an initial set of discussions identified several opportunities for improving our relationship with Alberta Health (AH) and AHS as well as some broad approaches to moving forward on health system improvement. I also mentioned that there were three important focus areas. Working groups were established to recommend specific proposals for these:

• An alternative payment plan option for primary care physicians.
• Advancing the meaningful use of electronic medical records (EMRs), including secure messaging.
• Supporting stewardship of health resources through clinical pathways and appropriateness and evidence-based initiatives.

The working groups met over the summer and provided reports at the end of August. The Alberta Medical Association (AMA), Alberta Health (AH) and AHS reviewed these reports in the first week of September. All of the parties are now considering what to do next. (For the AMA, deliberations include the Board of Directors and Representative Forum. Any significant amendments to the current agreement would require a ratification vote by members.)

The working groups did excellent work, identifying specific initiatives and the resource requirements to oversee and implement them. Attached to this letter you will find an outline of what has been discussed with AH and AHS, including the working group proposals. There is more detailed work to do in every case, but I think at least we are at the stage where we can decide which ones will be further worked upon. Note that there are three initiatives – secure messaging, the alternative payment option for primary care physicians and an AMA-AHS negotiating framework – that the parties have agreed to proceed to further development.

In my last letter, I noted some criteria that I thought would be important for the profession to take into account as we consider the various proposals. I’ve listed these below and provided my initial assessment:

Can a set of high-value initiatives be agreed to by all parties?

I think the working groups have demonstrated that there is no shortage of good ideas, but can we prioritize and focus our energy so that we can successfully implement them? Doing so would require commitment of all the parties, including at the most senior level.

How will initiatives be resourced? Who will fund what?

In the current financial environment, finding resources to carry out any of these initiatives will call for reallocation of existing commitments, not new dollars. If all the working group proposals were undertaken, it’s estimated the costs would run about $20 million a year for four years – a significant amount, although small relative to the annual provincial spend of almost $18 billion on health care.

The profession’s contribution could come from a variety of sources such as repurposing some of the benefits and programs to fund the proposed initiatives. Other approaches could also be helpful, such as introducing flexibility in programs like Continuing Medical Education.

AH and AHS will also have to demonstrate their commitment and contribute necessary resources. They will need to decide if they are willing to do so, just as we will.

How will we know if we are successful and how will success be shared?

For some initiatives, the outcomes are pretty clear. For example, in terms of secure messaging as explained in the attachment, we want a product that the profession finds useful and that will assist in meeting the privacy and security recommendations of the Canadian Medical Protective Association and the College of Physicians & Surgeons of Alberta. Ultimately, it must lead to more efficient and effective sharing of medical information and could provide the basis for patient-to-doctor communication as well. For clinical pathways, the measurement is more difficult and the allocation of success – the more efficient utilization of lab, radiology and other medical resources – more complicated.

Next steps

1. The AMA Board of Directors had its first discussion of the working group reports on September 16. The Representative Forum will receive a full report and provide input at its meeting September 25 and 26.

2. AH and AHS will also be considering their own take on the discussions and deciding what they want to do. Joint meetings at a senior level will also be important.

3. Three initiatives will move forward.

• Primary care alternative payment option: There are key tasks that remain in this initiative. All parties recognized the importance of the project and will continue to use best efforts in its development. There are still issues to be resolved, such as the resourcing of the necessary change management support.
• Secure messaging: The AMA will continue in its efforts to introduce secure messaging so that physicians can securely share patient information. To get the most out of this initiative will require collaboration among all the parties.
• Negotiating framework: The AMA and AHS will continue to work toward achieving this framework, which we hope will led to more effective and efficient negotiations process where AHS is the payer. A balanced and transparent dispute resolution process will be an important component.

4. Some of the initiatives being discussed can take place under existing arrangements: secure messaging is a good example. Others, however, which call for the reallocation of resources, will require some form of agreement. In that case, ratification would be needed by all parties, in our case a vote of the membership.

Concluding comments

The proposed projects build on what has already been done. From the overall budget perspective the resources needed are relatively small. I mentioned $80 million over four years, or $20 million a year. This is 0.11% of the province’s ANNUAL $18 billion health expenditures.

I believe it’s more important to think about the issues addressed in this letter than to focus on costs. Can the AMA, AH and AHS act in concert to make the fundamental changes needed to move to the new ways we must practice? Can we bring resources to bear on what we believe is best for patients? Can we share in success and thereby move from one-time initiatives to change that is reinforcing and self-sustaining?

This is also about the AMA. Our traditional role has been around the negotiation of rates and benefits, but the profession has also been interested in advancing and evolving patient care and value in the system.

We will keep you informed along the way and, as always, appreciate receiving your thoughts and comments. Email president@albertadoctors.org or leave a comment below.

Regards,

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

Attachment: Discussions with Government: Some Details