Primary Health Care Task Force

An Overview of the Primary Care Initiative

Wednesday October 27, 2010

Outline
Introduction

to Primary Care Networks

(PCNs) Brief Overview of Trilateral Committee Structure Implementation Research & Evaluation Questions
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Wednesday October 27, 2010

Overview of Primary Care Networks in Alberta

As of Oct. 1, 2010 38 PCNs in Alberta 2202 family physicians are part of a PCN 425 FTE Other Health Care Providers participating 2.5M enrollees Option to join is voluntary
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Wednesday October 27, 2010

Primary Care Initiative Committee

One

of the Strategic Physician Advisory Committees Mandate Broad responsibilities in planning, implementation and evaluation Equal representation of AHW, AHS and AMA

Wednesday October 27, 2010

Trilateral Governance
Primary

Care Initiative Committee (PCIC)

Trilateral agreement between Alberta Health and Wellness, the Alberta Medical Association and Albertas Regional Health Authorities

A reem nt S g e tructure
M te C m itte as r o m e

The

Program Management Office

P ys ian h ic S rv s e ice A gree en m t P ys h ician O e ffic S s mP gram y te ro A re m nt g e e

S creta e riat

Wednesday October 27, 2010

P ary C re rim a In tive itia A ree en g m t

Primary Care Networks

New way to deliver primary health care Local initiatives within provincial framework Formal arrangements between AHS and groups of physicians Defined roles and responsibilities AHS representatives and physicians in PCN jointly

Make decision Provide service responsibilities Receive payments

Wednesday October 27, 2010

PCN Governance
PCN

partnership is formed through a joint venture agreement between AHS and a not for profit corporation (NPC) formed by the physicians Partnership forms a governance committee to provide oversight for the network

Wednesday October 27, 2010

Primary Care Network Objectives

Increase access to primary care 24/7 management of access to appropriate primary care services Emphasis on: health promotion, disease and injury prevention, care of medically complex and chronically ill patients Improve coordination and integration of primary health services Greater use of multi-disciplinary teams
Wednesday October 27, 2010

PCN Service Responsibilities

16 Primary Care Services:

Basic ambulatory care Care of complex problems Psychological counselling Screening/chronic disease prevention Family planning and pregnancy counselling Well-child care Obstetrical care Palliative Care

Geriatric care Care of chronically ill Minor surgery Minor emergency care Primary in-patient care including hospitals and long term care institutions Rehabilitative care Information management Population Health
Wednesday October 27, 2010

PCN funding

PCNs operate within a mixed payment environment, receiving a per-capita payment of $50 per patient per year from Alberta Health and Wellness. Physicians continue to be compensated for insured medical services using either fee-for-service or existing alternate payment arrangements. In the past some PCNs also received funding from Capacity Building, Specialist Linkages and Pharmacy Grants.

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Wednesday October 27, 2010

Eligible under Per capita

New

services or service enhancements (e.g. other health care providers and incentives to expand comprehensiveness of existing services) Physician services not covered under the Physician Services Budget (PSB) or AHS.

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Wednesday October 27, 2010

What is a panel

Panels identify the patient population for which a provider is responsible. Panels are based on historical fee-for-service and shadow billing information for the last 3 years. The actual size of the panel determines per-capita funding for each PCN.

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Wednesday October 27, 2010

Four cut methodology

First cut Second cut Third cut Fourth cut single physician more than one physician, with one physician is predominant physician who did the last physical exam (03.04A) - no comprehensive physical, last physician seen

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Wednesday October 27, 2010

Contribution of Primary Care Networks

An

Evaluation (August 2008), assessed how PCNs increased access Comprehensive evaluation of PCI and PCNs to be completed in March 2011.

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Wednesday October 27, 2010

Evaluation of Primary Care Networks

Findings:

New service provider roles Expanded service New locations Education and screening programs Multidisciplinary teams New access strategies

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Wednesday October 27, 2010

PCN Impacts on
Improving

Access

Reducing wait times Reducing patient backlog waits Providing after-hours care Avoiding/limiting inappropriate ER use Linking unattached patients to primary care providers

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Wednesday October 27, 2010

PCN Impacts on
Health

Promotion and Disease Prevention

Improved identification of population health needs Improved integration between primary care providers Improved satisfaction with health promotion and disease and injury prevention

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Wednesday October 27, 2010

PCN Impacts on
Care

of Complex/Chronic Disease Patients

Enhances the role of family practice nurses Patient registries ensure more comprehensive care Integrating patients and providers with the right services

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Wednesday October 27, 2010

PCN Impacts on
Coordination

and Integration

Use of multidisciplinary teams Development of service responsibility agreements Patient referral/feedback mechanism Joint agency/program collaboration

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Wednesday October 27, 2010

PCN Impacts on
Multidisciplinary

teams

Co-location and centralized service delivery Effective teams with diverse skills Delegation of responsibility Enhanced information sharing among providers More comprehensive and coordinated care

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Wednesday October 27, 2010

Evaluation Conclusions
The

Evaluation found that networks

Aim for comprehensiveness Provide clinically effective services Build on the social capital in their community Focus on high need and high priority program areas

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Wednesday October 27, 2010

Other PCI related initiatives

New and expanded roles for health care providers. Chronic disease prevention and management Change management and access and process improvements (AIM) Research and evaluation

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Wednesday October 27, 2010

Research and Evaluation

Two Audits by the Office of the Internal Corporate Auditor (OCIA) Evaluation of Access through primary care networks Evaluation of the Primary Care Networks and Pharmacists Integration Project (completed) Evaluation of Primary Care Initiative Health Quality Council PCN Pilot (currently underway) Research: The Impact of Primary Care Networks on the Care and Outcomes of Patients with Diabetes
Wednesday October 27, 2010

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Research and Evaluation Next Steps

In the next seven to eight months:

Audit of the PCI Program by the Office of the Auditor General (OAG) CIHI EMR Standards Pilot Primary Health Care Strategy released by AHW

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Wednesday October 27, 2010

PCNs

In the past year the number of PCN has grown to 38 Approximately 2202 family physicians are in a PCN Other health care providers including nurses, dieticians, social workers and pharmacists are currently part of a PCN. More than 2.5 million patients are informally enrolled with PCNs. An additional four PCNs are in various stages of development

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Wednesday October 27, 2010

What is Next
Development

and release of a Primary Health Care Strategy by government Continued Support for PCNs and related Initiatives Work on an Evolved PCN model with an examination of existing policies Data - New Initiatives supported by grants
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Wednesday October 27, 2010

Questions?

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Wednesday October 27, 2010