Primary Care Alignment

1. Primary Care Alignment What this means for CHCs

2. Background • Provincial commitment to primary care reform in 2000 • Commitment to bring 80% of family physicians within reform process in four years • 2001 strategic review of CHC program and our role in reform process

3. 3 core service delivery areas for CHCs from review • Comprehensive primary care • Building community capacity • Integration and delivery of community-based programs

4. Other primary care service models • Family health groups • Family health teams • Family health networks • Solo family physician practices and group practices

5. What alignment means Key primary care renewal elements: • Common service delivery requirements • Client registration/enrolment • 24:7 on call/telephone health advisory service • Extended hours of service • Preventive care and comprehensive care incentives

6. Common service delivery requirements • Health assessment, diagnosis and treatment • Primary reproductive, palliative and mental health care; access to OB and newborn care • Episodic care; appropriate periodic health assessments • Service coordination including access to hospital care and coordination • Patient education and preventive health care Issues for CHCs • Emphasis on each requirement will vary based on populations served by CHC • CHCs provide most of these services already • Inter-disciplinary team-based service delivery model at CHCs

7. Client enrolment • All clients must be enrolled Issues for CHCs: • Many of our patients cannot be registered • Need to ensure still able to receive full scope of services • How will this affect incentive payments – currently only available for enrolled patients

8. 24/7 On-Call/Link to THAS • Provision of a 24/7 on-call in conjunction with a provincial THAS • Funding incentives to participate in THAS Issues for CHCs • Most CHCs currently have on-call arrangements • Concern re. access by certain patient populations • Perceived as an erosion of service by some

9. Extended hours of service • Reduces on-call demand and improves client satisfaction CHC issues • For some CHCs huge cost to providing extended hours (admin staff, security, remote locations, etc.)

10. Prevention/Comprehensive Care Incentives • Access to incentive payments for meeting prevention targets as well as for provision of comprehensive care Issues for CHCs • Calculations based on enrolled patients • Interdisciplinary team, yet only MD incentives • No capacity to track services in CHC system yet • Need direction re. how to pay out

11. Impact of primary care reform on Access Alliance • 50% of our patients are not currently enrollable; many more may not agree to enroll • Very high administrative and front line cost to enrolment as well as other aspects of service delivery model (staffing, translation of documents, interpretation of orientation, etc.) • Will incentives change practice over time? Will they affect retention of MDs?

12. Status of primary care alignment at Access Alliance • Common service delivery components in place (see JANC indicators) • Client registration will roll out in September (AAMCHC participated in a pilot) • 24/7 – we already have on-call, THAS not ready to roll out provincially yet • Extended hours – in place • Preventive care and comprehensive care – in place, however can’t track and won’t receive incentives