2023-24 Update on KRA 3, System partnership and leadership

Priority Activities

Year-end update

1. Support the sustainability of primary care practices and strengthen the Patient’s Medical Home for all Albertans: 

• Advocate for federal funding to be used toward sustaining existing primary care clinics and family physicians.
• Advocate for solutions previously brought forward by AMA to AH through the MAPS initiative, including: 
  • Removal of whites of the eyes rule.
  • After hours, extended hours.
  • Administrative burden compensation, hourly rate.
• Through the ACTT program, continue implementation of initiatives that support the Patient’s Medical Home, comprehensive care in Alberta (CII/CPAR, improve care coordination, Blended Capitation Model (BCM) or alternatives, governance education, provincial Communities of Practice in EMR, practice facilitators, physician champions). 

• ACTT and AMA Health Economics have worked with AH to secure a contractor to review ARP change supports for the release of the $2 million dollar grant. A completed report is anticipated in fall 2024. 
• ACTT continues to develop structures, templates and automation for new and existing BCM clinics to create efficiencies in model adoption, maintenance and change management. This includes practice agreement and business modeling templates that include learnings from onboarding one additional clinic this year in Banff. Regular community of practice sessions were held to support BCM clinic representatives collaborate and discuss successes, challenges and ideas in addition to shared experiences in the BCM journey. Additional clinics (66) engaged (using multiple avenues such as meetings, webinars and information sessions) to share information about the BCM model and the supports available. The purpose was to recruit and build interest in the model. Lastly, ACTT supported financial modelling discussions to explore and understand how total compensation on BCM compares to fee-for-service (FFS) for two clinics. 
• The AMA-ACTT program is well positioned to be a critical support in implementing and managing the change for the new funding model, the Physician Comprehensive Care Model (PCCM). Resources are available on the AMA website including a Q & A and Fact Sheet, with additional resources to come such as six webinars and a calculation tool. Additionally, AMA-ACTT is supporting change preparedness activities such as panel management support and adoption of CII-CPAR. 
• AMA Strike Team members have met regularly to advocate, share information with their respective executives for rapid input and endorsement, engage members broadly and represent primary care and family physicians to the best of their ability on issues including the development of the PCCM funding model, Transitional Funding Program (TFP) and Panel Management Support Program (PMSP) payments and reducing administrative burden. 
• AMA led the administration of the TFP and PMSP stabilization grants including supporting FAQ, webinars, communications materials and member inquiries. 
• ACTT continues to support physicians in the Physician Practice Improvement Program (PPIP) required though CPSA including 15 sessions being completed with over 600 physicians participating. 
• ACTT has held numerous network learning sessions to support PMH initiatives through its various Networks of Practice and Communities of Practice, including Physician Champion Network, Practice Facilitator Network and EMR Networks of Practice, and it launched a new Clinical Managers Network. The Physician Champion/Leadership Network, which is focused on peer-to-peer conversation, community and capacity building, has seen its membership grow (increasing 224% from 2023 to 2024), with membership expected to continue to expand. 
• As a key enabler of the Patient’s Medical Home, supporting provincial uptake of the Community Information Integration & Central Patient Attachment Registry (CII/CPAR) has been a top priority for the ACTT team since 2018. Supports include training through Learn@AMA, monthly connect sessions, dedicated support email, dashboards to support progress tracking, awards for PCNs achieving 80% adoption and ongoing promotion through various channels. 
• ACTT played a unique and critical role influencing, leading and strategically advising and supporting physician leaders to strategically lead or be involved in primary health care committees, and meaningfully participate in primary care governance at the provincial and zonal levels. This included creating awareness and input for the MAPS initiative. 
• Support for extended hours clinics is being incorporated into the new PCCM. 
• As part of the Market Rate Review preparation, AMA Health Economics is working with the Section of Family Medicine to review delegated/supervised services policies in other jurisdictions and to propose an expansion of services that would be exempt from the Schedule of Medical Benefits (SOMB) ‘whites of the eyes rule.’

2. Advocate for system and policy improvements and physician support that enable system interoperability and better flow of information, reducing patient risk and supporting continuity of care. 

• Investment in Connect Care improvements for providers practicing in AHS facilities and the community (e.g., identify viable solutions to address the ongoing challenges for accessing and routing information for mixed context providers and community providers working at more than one location). 
• An effective EMR vendor business model (e.g., standards, integration incentives, secure information exchange, etc.). 
• Advocacy for the modernization of the Health Information Act to address barriers in patient information. 
• Advocate for system and workflow improvements through the eHealth Modernization project. 

• AMA continues to advocate through various committees and work closely with AHS and physician leaders on all Connect Care issues. System, workflow, results delivery and communication issues continue to improve with further changes expected in 2024. 
• AH recognizes the priority of an EMR business model and continues to work on developing a proposed EMR model based on ongoing discussions over the past few years with physicians, EMR vendors and other jurisdictions. Project was launched in July 2024. 
• Advocacy work continues across several fronts, including various committees and meetings with AH senior leadership on the modernization of the HIA. The Privacy Commissioner attended RF to have an open discussion with members on their concerns and current priorities for the Office of the Privacy Commissioner. 
• Significant work has been done through the eHealth Modernization Project on functional and infrastructure requirements for the health system. Due to the refocusing work, this project has paused, however, work on key priorities continues with AH while ministerial direction is solidified.
• Informatics priorities will continue to evolve and adapt as the four pillars are implemented across the health system.

3. Advocate for solutions that address the health human resource shortage and improve patients’ access to a physician: 

• Advocate for the Alberta Surgical Initiative to be co-designed with the profession. 
• Develop and implement the program provided for in the AMA Agreement to support recruitment and retention for physicians who practice full time in underserviced areas. 
• Make recommendations to the Minister of Health on physician supply and distribution, through the Physician Resource Planning Advisory Committee to be established under the AMA Agreement. 

• To support the work of AMA’s involvement in the multi-stakeholder PRP Advisory Committee, as well as any other issues that deal with human health resources, the AMA formed an AMA PRP Working Group. The working group meets regularly to support recruitment and retention issues as noted in Schedule 7 of the AMA Agreement – Targeted Investments of the AMA Agreement. 
• The AMA’s PRP Working Group last met on April 10, 2024, where discussion included an update on the ongoing collaborative efforts to accurately assess the physician workforce in Alberta, as well as discussions on current AHS’ recruitment challenges and strategies and the ongoing dialogue surrounding the anesthesia workforce crisis in the province. The working group is meeting next on September 9, 2024. 
• As mentioned above, the AMA has begun collaborating with CPSA, HQCA, AH and AHS to comprehensively grasp and address the challenges within the physician workforce. By leveraging their respective datasets, these organizations aim to develop a more comprehensive understanding of the province's current physician resources. 
• The first meeting of the stakeholder group was held on June 19, 2024. During this meeting, the group further defined the project’s scope, including seeking data related to physician resource numbers, practice scopes and demographics. Additionally, the group established a plan forward and decided to engage with other pertinent agencies as needed. The stakeholder group’s next meeting is on September 9, 2024.

Priority Activities

Year-end update

1. Explore alternative compensation models and alternatives to FFS payment, including: 

• Models for interdisciplinary physician teams. 
• In partnership with AH, evaluate BCM implementation and other alternatives for funding comprehensive primary care. 

• Under the Memorandum of Understanding (MOU) between AH and AMA, the strike team continues to work with AH to develop the new PCCM to stabilize community-based primary care practices and incentivize continuity and comprehensive care for Alberta patients. A joint AH-AMA proposal on rates has been put forward by the Rates Committee and Management Committee and is currently being considered by the Minister of Health. A joint final report with program details is also being finalized. 
• A proposal for improvements to the Capitation and Blended Capitation Models has been put forward to the ARP Working Group that aligns with the development and implementation of the new PCCM.

2. Advocate for the implementation of the ‘top 10 priorities’ developed by the AMA’s cARP Working Group (i.e., contractual agreements with fair dispute resolution, expedited application and approval processes, simplify payment models, fair and timely funding adjustments for service volume, etc.). 

• The ‘top 10 priorities’ were raised at the AH-AMA Clinical ARP Working Group. A workplan was developed which groups these priorities into short-, intermediate- and long-term goals. AMA’s rate methodology was tabled at the working group on November 7, 2023, and weekly meetings have been occurring since. Contractual agreements are being discussed and AMA has proposed a contract template to replace the less desirable Ministerial Order mechanism. AMA has also proposed a simplified/expedited application and approval process as well as a more simplified payment model and full-time equivalent (FTE) definition.

3. Operationalize administration of the CII/CPAR member funding program under the AMA Agreement. 

• The CPAR program has been operationalized and payments are being made quarterly. Staff are working with members and AH to help resolve any issues or questions arising from the funding program.

Priority Activities

Year-end update

1.    Regularly and frequently explore issues of importance to patients through albertapatients.ca.

• Report results to physicians, the public, government, AHS and other stakeholders. 

• Albertapatients.ca has been used to inform AMA strategy and advocacy. In this current business year, we have explored: Albertan’s assessment of the general state and directions of the health care system; government’s performance on same; satisfaction with primary care experience; attitude toward use of alternative providers such as nurse practitioners and preferences in teams vs independent; awareness of the financial situation of physician practices. 
• In May we conducted an in-depth survey to prepare for 2024-25 business and advocacy planning. Results will be shared with the RF and members through the Report to the Annual General Meeting. Selected results have been shared with public and media through the President’s Letter and social media. We will continue to do so as strategic opportunities present. The AMA president has shared results in discussions with the Health Minister. 

2. Leverage the PatientsFirst.ca platform by: 

• Asking Albertans about their patient experience, e.g., waiting for care. 
• Helping Albertans to make their voices heard by provincial or constituency political leaders who need to know what matters to patients. 

• PatientsFirst.ca has been integral to the AMA’s push for our proposal toward the PCCM and for funding to be delivered in the context of Budget 2024. 
• Over 4,000 emails had been sent by Albertans to MLAs in the month of January expressing support for primary care as a Budget 2024 priority while advertising continues to build volume and add new members to the PatientsFirst.ca community. At time of update, members of the online community were actively engaged, receiving AMA messaging and participating in activities such as talking to MLAs or sending emails. 
• The SOS The Urgency Is Real campaign is linked to PatientsFirst.ca via videos that physicians have uploaded to talk about their personal stories in the struggle to sustain their practices.
• In July, the PatientsFirst.ca community passed the 50,000-membership mark and we continue to grow. Paid advertising at intervals and AMA social media are included. There are also regular direct communications with the community members. The platform will be part of our ongoing strategies for government and public relations. More information will be presented during the Fall RF meeting.

3. With external polling services, bring general population research findings about what patients say and value to AMA system partnership and leadership efforts. 

• This item has been incorporated into the albertapatients.ca item, above. That poll originally was subscriber-based and consisted of patients in the system. Results, while informative, were not statistically generalizable to the Alberta population. With changes made to the operation of the platform, we are now polling Albertans at large on these matters under the PatientsFirst.ca banner. This eliminates the need to run separate polls when we may need to use results for public relations or lobbying purposes.