Doctor-run PCN system in Alberta gets praise

Do primary care networks do a better job of supporting the highest standards of patient care when they are run by doctors—who are resilient, trained to work as fast as required and are committed to providing the best care for their patients? A quick look at Alberta’s Primary Care Networks (PCN) would suggest the answer is yes. First of all, Alberta’s PCNs started organically and locally at the FP level—with doctors meeting in their homes, sitting on carpeted floors and hashing things out, as the legend goes. The history of Alberta PCNs is nearly two decades long and governance has become more complex, with Alberta’s single provincial health authority—Alberta Health Services—now taking an oversight role and more structured management of the initially scattered approach. You can explore the evolution and governance details here. Read: Has B.C.’s fledgling team-based care initiative been preempted by the urgent need to attach patients? But within that governance structure, Alberta doctors are organized into district non-profit corporations. Through the PCNs —which are a separate layer that kind of sits on each district non-profit—they do all the hiring and employing of staff and choose what kind of support they need. They set their community’s priorities. The Alberta PCNs’ grassroots “cowboy” origins are too respected to undo. Physicians still play the key role, running PCNs with the purpose of achieving gold standard primary care priorities. Alberta has an advanced, seamless provincial IT system called Netcare to help them do that. FPs have their own EMRs but they can feed data into Netcare to do metrics and quality improvements. Doctors initiate and manage their own quality improvement projects. The strengths and weaknesses of the PCNs can be routinely and accountably evaluated, and they are guiding FPs in delivering primary care. The physicians the Medical Post spoke to were extremely positively about how they feel about working in the system. Dr. Lana Wicentovich lives and works in British Columbia now. But for many years she practised in Lethbridge, Alberta, serving as a director on the board of the Chinook Primary Care Network. “Different PCNs each operate a little bit differently,” Dr. Wicentovich said in an interview, “but the allotment of funding to each PCN from Alberta Health is determined by patient attachment and in each regional catchment area.” There is a standardized method for determining which doctor a patient is attached to. And then a set amount—$62 per attached patient—flows into that primary care network. To participate fully in Dr. Wicentovich’s PCN, “we accommodated all sizes of practices, regardless of if you were practising in a semi-urban or rural location. Our PCN board was large, because each clinic in the region (regardless of size) had a director represented around the board table. In addition, our board had a member of the community and members from Alberta Health Services.” “We had a big board, because every clinic was represented around the board table plus a member of the community. And that was balanced with four members from Alberta Health Services. “This is what provided balance on the board,” Dr. Wicentovich said. Fifteen per cent of the funding was set aside for the central office business operations. “A stipulation for this money is that it had to be spent on human resources (at least 80% toward salaries) to enhance our care and give us the ability to practice with an in-house team, developing a medical home for our patients” she said. “Each participating clinic needed to hire a clinical care coordinator who would be a liaison point, the person that would be responsible for reporting back to the central office what our clinic’s initiatives were, and how we were meeting those objectives.” The rest of the money was for patient care. “We would have regular meetings for the PCN doctors. We’d work on initiatives for our patient population, to enhance their care. And we would hire the staff with that funding to support our initiatives.” The PCN doctors at Dr. Wicentovich’s clinic could enhance their teams by hiring nurses, pharmacists, counsellors, physiotherapists (etcetera) with the funding—depending on the needs of their patients. Included in Dr. Wicentovich’s PCN was access to a data analyst who could run metrics for the physicians to help them be more efficient and provide better patient care. “We had one of our nurses work on a project to ensure that we were getting all hospital discharge data for the entire clinic, having the nurse vet that data every working day. This allowed us to call recently discharged patients, via our nurse, to ensure they had proper follow up and to intervene in a timely fashion if patients were doing poorly. “We also, as a region would have clinical indicators that we wanted to see, to inform us on how our work was moving the needle on metrics such as cancer screening. Are the breast cancer screenings happening? Is the colon cancer screening happening? Are people being screened for blood pressure? If they’ve had their blood pressure checked, are we treating hypertension to target?” All of these initiatives, the decisions about how best to improve patient care, were made not by health authorities or bureaucrats, but the physicians in the district PCN. “I felt that this model was incredible, because funding is flowing via patients to enhance the medical team. The money is for every person that resides and seeks care in the region, and the money is to support every physician that wants to be part of our PCN, to aid in building a medical home for their patients.” Dr. Wicentovich said. About 87% of Alberta FPs practice within the PCN system. They all have the option, but it is voluntary. Dr. Jordan LaRue is a family physician who has practiced in Sylvan Lake—15 minutes west of Red Deer (which is right between Edmonton and Calgary). He has been very active, both locally and provincially, in the management of PCNs, and is a strong believer in Alberta’s system. “We’ve had primary care networks go through 15 plus years of evolution to get to where we’re at today. And we’re not done,” he said in an interview. “We’re already looking to what’s in the next 5 to 10 years. And I think we have the engagement at tables … we’re starting to actually speak in similar languages and understand each other better. So not only am I being heard (by the health ministry, by Alberta Health Services and representatives from other PCNs), I’m actually hearing my partners. And I’m starting to see them as partners that I need to work with. What are our common goals? How do we advance this? How do we make it better? What is the next step even?” “You know, maybe I don’t have the answer. Or maybe the answer is unclear. Or maybe we don’t even agree. But now there’s actually a table to talk (at). And we keep coming back to it,” Dr. LaRue said. He’d love to see the per-patient PCN funding increased from $62 to $200, and he’s optimistic that could happen.With Netcare and all the data that is available, Alberta FPs could demonstrate the cost effectiveness of FPs in preventing more serious illness and keeping patients out of emergency rooms. “I look forward to a fully supportive system, with some permanency to it, that is fully integrated with the rest of the healthcare system, and provides world class, primary healthcare,” Dr. La Rue said. “I mean, PCNs have created a wonderful structure to build upon. We’re not there yet. But they have made the argument for their value.” “They proved themselves in the COVID response. Our Calgary PCNs evaluated their COVID work, and found that 97% of COVID patients were seen in primary care. We kept those patients out of the hospital. We kept them out of emergencies. We helped do our part to ensure that the tertiary care system didn’t collapse. “I think more needs to be done and I’m not just being greedy about that. There is evidence In terms of what a fully-funded primary care system would look like, and that would probably need around $150 to $200 a patient.” That’s a significant leap— from $62 to $200 a patient. But with “let’s get it done” Alberta doctors driving the process, you never know, it could happen. Ann Graham Walker is the Medical Post’s B.C. writer.

Doctor-run PCN system in Alberta gets praise

Register for free access or login.

Related Topics