The panel payment component of the Primary Care Physician Compensation Model (PCPCM) recognizes the continuous relationship between a family physician and their patient and acknowledges increased demands placed on physician practices by complex patients.
Panel payments for PCPCM are determined by the number of patients attached to a family physician’s PCPCM panel (derived from CPAR) and which cell within the complexity matrix the patients fit within.
Step 1: Complexity Categories
All Alberta residents are assigned to a complexity category using the Canadian Institute for Health Information Population Grouping Methodology (CIHI Pop Grouper). Alberta Health runs CIHI’s program using multiple data sources containing demographics and health care data.
Health Care Data Sources
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Physician claims
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Ambulatory care
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Inpatient
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Home care
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Long-term care
Types of Data Utilized
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Medical diagnoses (ICD-9 and ICD-10)
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Healthcare system usage
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Age
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Gender
Alberta residents are placed in one of seventeen complexity categories:
- Healthy newborn
- Major acute
- Major cancer
- Major chronic
- Major mental health
- Major newborn
- Minor acute
- Minor chronic
- Moderate acute
- Moderate chronic
- Non-users
- Obstetrics
- Other cancer
- Other mental health
- Palliative
- Users without health conditions
- Unassigned
The last category of “Unassigned” is for residents with insufficient data for classification.
Step 2: Age and Gender
Alberta Health further separates residents by age and gender to create a complexity-adjusted payment matrix.
Gender Categories
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Female
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Male
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Unknown or Other - categorized as Male
Age groups: 0-1, 1-17, 18-34, 35-49, 50-64, 65-79, and 80+.
Step 3: Payment Calculation Matrix
Once patients are assigned to a cell within the matrix, the funding value of the cell is determined. Alberta Health uses the total cost of primary care physician visits and divides that by the number of residents in that cell to create an average cost per patient.
Example Assignment: Major Acute – Female - 18-34
When calculating the PCPCM payment, it uses a proportion of the Blended Capitation Model (BCM) where the average patient rate is $306.60. In PCPCM, the average patient is currently paid at $70.25 per patient, which is 22.9% of the average rate for BCM.
Step 4: Adjusting for Funding Increases
To account for funding increases in the Alberta Medical Association’s SFM agreement with Alberta Health, the values from Step 3 sometimes need to be adjusted, as they reflect the cost values from prior years.
Macro-allocation rate increases are calculated by multiplying the prior year’s value by the rate increase. For example, if the SFM were to receive a 5% increase in the future, here's the adjusted rate:
[Previous Year Avg Cost $] X [Current Year % Rate Increase] = Adjusted Rate
$70.25 X 1.05 = $73.76
Schedule 3
2022/23, 2023/24 & 2024/25 Macro-Allocations
|
AMA Member Section |
Year 1 (2022/23) Rate Increase |
Year 1 BCP Increase Estimate |
Year 2 (2023/24) Rate Increase |
Year 3 (2024/25) Rate Increase |
Compounded Increase First Three Fiscal Years |
|
AMA Member Section Family Medicine & Generalists in Mental Health |
Year 1 (2022/23) Rate Increase 1.35% |
Year 1 BCP Increase Estimate 0.89% |
Year 2 (2023/24) Rate Increase 1.48% |
Year 3 (2024/25) Rate Increase 1.48% |
Compounded Increase First Three Fiscal Years 5.25% |
Source: AHCIP Bulletin MED 280
Fee for Service Retroactive Payments for 2024-25 Fiscal Year
Note on CIHI: Several panel complexity calculations were explored and the CIHI methodology was determined to be the best option as it considers the most factors and is both transparent and proven. The methodology is used across Canada and is publicly accessible. AMA physician leaders are confident that CIHI is the right choice for the PCPCM.
More Resources
- More information on the CIHI Population Grouping Methodology can be requested from pcpcm
@albertadoctors ..org - Watch a short video on the Population Grouping Methodology.