Patient Affiliation - Blended Capitation Model

What is patient affiliation?

Patient affiliation is formal panel identification. Patient affiliation identifies the panel per physician and per clinic. This is the mechanism Alberta Health uses to know which patients have an ongoing relationship with the clinic/doctors to determine the compensation (capitation payments). Patients will sign an affiliation form. It is essentially a two-way, voluntary, consensual relationship between the physician and the patient. The physicians and the clinic team are responsible for initiating the discussion with patients. The discussions will focus on the responsibilities, benefits, and expectations of affiliation to all the parties involved.  It will also be used to obtain patient and physician signatures.

Who do we affiliate and by when?

There are three groups of patients which are provided below:

1. Initially validated patients.  These patients will be frontloaded to the roster (nb: signed affiliation must be completed within 24 months after beginning BCM)
   Tip: Clinic staff can opportunistically work on this list
2. Patients on your panel who were not validated by AH can be affiliated and added to your roster prior to BCM starting and after the start date
3. Any new patients can and should be affiliated as soon as possible to begin to receive payments
   Tip: The primary focus should be on Groups 2 and 3, to ensure BCM payments begin to flow immediately.

What are the affiliation process requirements and considerations?

Requirements:

• Both the patient and the physician must physically sign the affiliation form – currently only a “wet signature” is acceptable
• A copy of the original affiliation must be kept on file in a secure location (paper and/or scanned EMR storage)
• Evidence of a therapeutic relationship must be in place (e.g. - billing, chart notations etc.)
• Newly added patients (not front loaded, must be added via the CPAR roster function, noting the date)
• Front-loaded patients who refuse to sign must be de-affiliated noting the date via CPAR. The patient does not have to sign a de-affiliation form, however, it must be noted in the chart the patient has declined further association with the clinic as their medical home.

Considerations and Suggestions

• As patients come into the clinic, the clinic staff should explain BCM and obtain patient signatures
• Any net new patients, by the second visit, must get the affiliation form signed if the patient would like to continue care with the clinic

Suggested Action Items for the Clinic

• Create draft of scripts (in-person and phone)
• Create draft of patient brochure (consider content for website, social media)
• Create draft patient affiliation email
• Start process mapping steps necessary for affiliation
• Determine roles and responsibilities

Scripting guidance

Guidance for the clinic team members to communicate with patients should be:

• Efficient
• Effective
• Patient-centred manner
• Standardized approach

Scripting elements to consider
When creating the script, consider the following:

• Using ‘key points’ versus word-for-word script so the user sounds natural
• Practice ahead of time – don’t read from a paper
• If the patient doesn’t know you, start by introducing yourself, include your role in the clinic
• Make sure the patient knows that you’re conveying information on behalf of their physician or other primary provider
• Consider language – are you using terminology or acronyms that may not be familiar to the patient?
• Build in opportunities for the patient to provide input. E.g. - Has someone already talked to you about this? Does that make sense for you?
• If applicable – allow time to think it over and return at a mutually agreed upon date with a decision and to sign the affiliation form
• Include ideas for handling different situations, should they arise. E.g. - chatty patients, those who want to /need to talk with the physician