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  • PCNEVOLUTIONDISCUSSIONDOCUMENTDRAFTDOCUMENT

    Version0.14(ReviewedandamendedatthePCNPhysicianLeadsForumonOctober15,2011)

    October2011

  • Page2of21

    TableofContents

    PREFACE:.......................................................................................................................................................3

    1.0GlossaryofTerms...................................................................................................................................3

    2.0GuidingPrinciples...................................................................................................................................3

    3.0PrimaryCareInitiativeGoals..................................................................................................................5

    4.0TheJointVenturePartners....................................................................................................................6

    4.1ChallengestoJointVentures..............................................................................................................6

    4.2StrengthsofJointVentures...............................................................................................................7

    5.0ServiceAreasinPrimaryCareforaPopulation.....................................................................................7

    6.0Governance............................................................................................................................................9

    6.1ProvincialGovernance.......................................................................................................................9

    6.1.1ProvincialManagementCommittee(underanewMasterAgreement)....................................9

    6.1.2ProvincialJointVentureGovernance(NPCPhysicianLeadExecutive/AHSExecutive)..............9

    6.2ZonalNPCPhysiciansandAHSRepresentativesGovernance..........................................................10

    6.2.1RolesandResponsibilitieswithinaZonalNPCPhysiciansandAHSRepresentativesGovernanceStructure.........................................................................................................................11

    TherolesandresponsibilitiesoftherespectivepartieswithinaZonalGovernanceStructureisoutlinedbelow:...................................................................................................................................11

    6.3LocalPCNGovernance.....................................................................................................................12

    6.3.1KeyElementsofaGovernanceModel......................................................................................12

    6.3.2RolesandResponsibilitieswithinaLocalGovernanceStructure.............................................13

    7.0InformationManagement....................................................................................................................15

    8.0Funding.................................................................................................................................................15

    8.1FundingFlow....................................................................................................................................15

    8.2FundingMethodology......................................................................................................................15

    AppendixA..................................................................................................................................................17

    AppendixB..................................................................................................................................................18

    AppendixC..................................................................................................................................................21

  • Page3of21

    PREFACE:Thisdocumentisintendedtooutlinethethoughts,ideasandpositionofPrimaryCarePhysiciansinpreparationfordiscussionsonthefuturedirectionofPrimaryCareNetworks(PCNs).Elementswithinthisdocumentwillneedtoguidenegotiations,withrespecttoPrimaryHealthCare,foranewMasterAgreement,anyassociatedCommitteesorTaskForceandanyprovisionsoutlinedwithinanewAgreement.ThecontentsofthisdocumentreflecttheconceptsdiscussedandsupportedbyallPrimaryCarePhysiciansandPhysicianNotforProfitCorporations(NPCs).

    1.0GlossaryofTerms

    FormalAttachmentorAffiliationmeansaformalizedagreementbetweenapatientandanindividualphysicianoutliningthetermsoftheirrespectiverelationship.

    GovernanceCommitteereferstothebodyformedfromtheJointVentureandincludesequalrepresentationfromthePhysicianNPCandAlbertaHealthServices.ThemainfunctionoftheGovernanceCommitteeistoplanandstrategizeservicesforthedefinedpopulationservedbythePCN.

    JointVenturereferstotheAgreementformedbetweenAlbertaHealthServicesandthePhysicianNPCtojointlystrategizeandplanforthePCN.TheJointVentureAgreementoutlinestherespectiverolesofbothAHSandthePhysicianNPCandwherejointaccountabilityandresponsibilityisshared.

    LocalreferstothetargetedpopulationgroupservedbyaPrimaryCareNetwork.

    NotforProfitCorporation(NPC)meansthephysiciansnotforprofitcorporation.TheNPCisalegalentityformedbyinterestedphysiciansjoiningtogetherforthepurposesofworkingtogetherto improve primary care. Projects providing better service programs, primary care research or teaching and partnership with any stakeholder are possible to accomplish those goals. AHS is a major partner and stakeholder and with the NPC form the local PCN.

    NPCAdministrativeServiceBureaureferstoproposedbodythatPCNscancontractwithforadministrativeservicesthatarecommonbetweenPCNs(e.g.,finance,humanresources,evaluationservices,etc.).

    PrimaryCareNetwork(PCNJV)meansajointventurebetweentheNotforProfitCorporationandAlbertaHealthServices.

    2.0GuidingPrinciples

    Thewords primarymedical care and primary health are often used interchangeable but one isessentiallyasubsetoftheother.TheWorldHealthOrganizationreferstoPrimaryMedicalCareastheclinicalservicesprovidedpredominantlybygeneralpractitionersand/ormultidisciplinaryteamsunder theirdirection. PrimaryHealthCare refers toabroaderconceptwherephysicianspartnerwith the community to develop strategies on all aspects of health and subsequent action (e.g.,diseasepreventionactivities,healthpromotion,etc).

  • Page4of21

    Localsolutionstolocalproblemso Theservicesidentifiedandtheresourcesbeingallocatedmeettheidentifiedneedsofthe

    communitybeingservedo The NPC is an autonomous physician legal entity able to engage in any project or partnership

    to serve the purpose of improving primary care.

    FundingflowsdirectlytotheindividualNPC

    PhysicianledpatientcareteamthatishiredandmanagedbythePhysicianNPCandorapartnership.

    AppropriateEngagemento PhysicianNPCisanessentialcomponentofaPCNo ThetwoJointVenturepartnersareencouragedandexpectedtobringtheiruniqueroles

    andcontributionstothePCN

    SufficientandSustainableo Anyadditionalresponsibilitiesrequestedbyafunder(e.g.,AHW/AHS)wouldneedtohave

    additionalresourcesaccompanyingtherequestinorderforthemtobeimplementedo Resourcesarepredictableo Resourcesareusedefficientlythroughoutthesystemo Thereisacommitmentandfollowthroughtoremoveunnecessarybureaucracyo Qualitywork/lifebalanceforphysiciansandteams

    ClinicalandProfessionalAutonomy

    Theskills,knowledgeandexpertiseofallprofessionalgroupsshallberespected.Evaluation

    Evaluationiscentraltodeterminingifstatedgoalsareachieved.Todothiseffectively,evaluationneedstobebuiltintoallprocessesandplannedupfrontusingevaluationexperts.Thereareseveralareaswhereevaluationisimportantincludingbutnotlimitedto:

    1. InternalPCNFocus Planning/efficiency

    o ensuringthatthereisajustificationforapolicy/programandthatresourcesareefficientlyandeffectivelydeployed

    Accountabilityo demonstratinghowfarthePCNhasachieveditsobjectives,howwellithasused

    itsresourcesandwhathasbeentheimpact

    o GovernanceandAdministrationeffectiveness

    Implementation/ContinuousImprovemento improvingtheperformanceofprogramsandtheeffectivenessofhowtheyare

    deliveredandmanaged

    2. PrimaryCareInitiative

  • Page5of21

    DeterminetheoverallsuccessofthePrimaryCareInitiativeonthehealthsystembyassessingtheoverallimpactPCNscollectivelyonthehealthcaresystemandimpactonpopulationhealthefforts.

    Aprovincialframework,fundedprovincially,shouldbedevelopedtoassistandsupportthepartieseffortsinevaluation.

    3.0PrimaryCareInitiativeGoals

    AppendixAcontainstheobjectivesofthePrimaryCareInitiativeundertheformerTrilateralMasterAgreement(TMA).ThefollowinggoalsareconsistentwiththeAMAsPrimaryandChronicCareStrategyandtheGovernmentsFiveYearActionPlan.

    1. FirstContactCare/Access Theprimarycareproviderservesastheusualentrypointintothehealthsystemforeach

    newneedforhealthservices,exceptinthecaseofseriousemergencies.

    Theprimarycareprovidereitherprovidescaredirectlyorservesasafacilitator,directingpatientstomoreappropriatesourcesofcare.

    2. Continuous(ongoing)Care

    Continuouscarereferstothelongitudinaluseofaregularsourceofcareovertime,regardlessofthepresenceorabsenceofdiseaseorinjury.

    Thefocusisonthecreationofaphysicianledmedicalhomerecognizedbyboththepatientandthephysician.

    Continuouscareovertimeisintendedtohelptheproviderandthepatientbuildalongtermrelationshiptofostermutualunderstandingbetweenproviderandthepatient.

    Requiresidentificationofapopulationforwhomtheserviceorproviderisresponsibleanditrequiresanongoingpatientfocusedrelationshipovertimebetweenprovidersandpatient.

    3. CoordinatedCare

    Linkingofhealthcarevisitsandservicessothatpatientsreceiveappropriatecareforalloftheirhealthproblems,physicalaswellasmental.

    Theessen