Integrated Health Services Coordination & Delivery Associations Meeting March 31, 2016

meaningful contribution to the healthcare transformation in Canada 2 is in the care business Medavie is a diversified health services company dedicated to making a meaningful contribution to the healthcare transformation in Canada through integrating benefits management, health management, and health care delivery © Medavie Inc.

3 Medavie EMS Medavie EMS oversees operations for a number of subsidiaries in the fields of emergency medical services (EMS) and public safety, EMS and clinical training, and mobile and community health solutions. Operations are located in the Maritimes, Ontario, Alberta, Saskatchewan, and Massachusetts The largest private ambulance company in Canada A workforce of 3,900 including clinicians, management and administration staff A fleet of 550+ vehicles including ambulances and support units Over 500,000 annual requests for service Partnered with Dr. JP Arseneau at the Clinique Médicale Nepisiguit in Bathurst, NB © Medavie Inc.

4 Current State There are a number of ongoing issues that are challenging the sustainability and efficacy of the health system. Fiscal Reality: Goal of finding efficiencies and capacity in healthcare system Looming changes to federal health accord Choices outlines initiatives being considered within Strategic Program Review The Alternate Level of Care Summit highlighted systemic issues including: Highest % of ALC bed days in country High rates of chronic disease Regional variations in service level Need for increased health system integration In 2011, the New Brunswick Health Council recommended that: “The Government of New Brunswick, through the Department of Health, review the organization and delivery of primary health care in the province with a view to maximizing the utilization of existing human and financial resources.” © Medavie Inc.

A new Part III entity was formed “Ambulance New Brunswick” 5 Our Experience In 2007, a similar arrangement was created: The collective agreements in place in 2007 (CUPE & NBNU) are still in force today and include ANB employees as members. NB EMS has a very collaborative working relationship with both unions. We look forward to continuing this relationship with these two unions and NB Union as well if the proposal goes forward. A new Part III entity was formed “Ambulance New Brunswick” ANB consists of Paramedics, Emergency Medical Dispatchers and Flight Nurses ANB is managed on behalf of the government of New Brunswick by New Brunswick EMS, a subsidiary of Medavie EMS © Medavie Inc.

This exploratory phase will take 4-6 months. Medavie EMS Mandate The Government of New Brunswick has entered into a Memorandum of Understanding with Medavie EMS. Key facts: The MOU will explore the possibility of enhanced primary health care provision in the community. This exploratory phase will take 4-6 months. The deliverable at the end of this timeline is a proposal for a strategy and implementation plan. © Medavie Inc.

Integrating Ambulance New Brunswick (ANB), the 7 Medavie EMS Proposal Integrated health services coordination and delivery The proposed model would improve the patient experience and create more capacity in the health care system by: Integrating Ambulance New Brunswick (ANB), the Extra-Mural Program (EMP) and Tele-Care 811 into a new Part III company Developing a Health Services Coordination Centre (HSCC) by leveraging the Medical Communications Management Centre operated by ANB and Tele-Care Developing care pathways for patients with complex needs in collaboration with the patient, Primary Care Provider, Extra-Mural Program and Ambulance New Brunswick resources © Medavie Inc.

Medavie EMS Proposal Governance Model 8 Medavie EMS Proposal Governance Model The new management company would be contracted to operate and manage EMP/ANB while providing oversight to the current 811 contract © Medavie Inc.

Medavie EMS Proposal Capacity improvement and synergies 9 Medavie EMS Proposal Capacity improvement and synergies Administrative efficiencies All resources working to top of scope Optimal match between patients and providers Establishment of community paramedicine (resources are already available, but not used currently) Optimal management of patients in the community leading to a decrease in Emergency Room and hospital use © Medavie Inc.

10 Roadmap to the Future State Medavie EMS developed a roadmap for New Brunswick in collaboration with the Department of Health. This roadmap outlines a multi-phased approach to realizing the inherent opportunities to improve the patient experience and create more capacity in both the primary and acute care system. Integrating ANB, EMP and 811 1 Developing a Health Services Coordination Centre 2 3 Leveraging HSCC and integrated workforce to focus on the management of complex patients over time © Medavie Inc.

Future State Integrated health services coordination and delivery 11 Future State Integrated health services coordination and delivery The Medavie EMS proposal is aligned with the recommendations in the primary health care framework, government commitments and recommendations from the New Brunswick Health Council. Expected improvements: Patient and provider experience Access to primary health care Increased capacity in community and acute care Reduction in Emergency Room and hospital usage Management of patients with complex needs in the community Accountability © Medavie Inc.

Stakeholder Engagement 12 Stakeholder Engagement Our journey so far We have met with: RHA CEOs EMP Managers NBNU NBU CUPE Associations Social Development Healthcare Leaders Designated Medavie EMS representatives have now had sessions on policies and procedures prior to going on site visits. © Medavie Inc.

13 Associations We know that you have many questions. We would like to take some time to answer your questions, knowing that we do not have all the answers at the moment. Your input and involvement as we move forward will be essential. © Medavie Inc.