1. Opportunity Knocks: A New PCN Governance Framework
Presented by:

2. Community Specialty Care
Current State H
Community Services
Pharmacy
Services
Mental Health
PCN
Clinic
Community Specialty Care
Primary Care Networks (PCNs) have been an integral part of primary health care in Alberta for over a decade.
There are currently 42 PCNs in operation in all five zones across the province, providing local services for local needs. AN ABILITY TO CONTINUALLY GROW AND EVOLVE TO MEET THE CHANGING NEEDS OF ALBERTANS HAS BEEN THE FACTOR FOR SUCCESS.
The success of PCNs has provided the opportunity to reshape the direction that primary care is taking in Alberta. The implementation of the Patient’s Medical Home has built a solid foundation but significant work remains.

3. Current State (continued)
Minister
Deputy Minister
42 Grants/ Funding
PCN Consultation Committee
Primary Care Networks
Primary Care Networks
Primary Care Networks
Primary Care Networks
Primary Care Networks
Currently the structure requires each of the 42 PCNs to communicate with Alberta Health independently. This silo approach limits the opportunity to integrate at a zonal level and expand PCN services at the zonal level with Alberta Health Services. It’s also missing an important communication link between the provincial committee and to PCNs.
Alberta Health Services (AHS) and Alberta Health (AH) have partnered with PCNs since their inception and also have a key role to play in the planning and provision of community-based services. PCNs are a Joint Venture between Not for Profit Physician Corporations (NPC) and Alberta Health Services.
Since the 2016 PCN Review, there has been a desire to build on this solid foundation and to further evolve the structures and processes to facilitate even closer partnership, collaboration and planning activities.

4. Commitment
“Integration is key to Albertans getting the care and services they need in a timely fashion, and it’s key to ensuring Albertans don’t fall through the cracks. It is a path that will take time, and it will take tremendous collaboration. It is a path that builds upon – and supports – the great work already happening on the front-lines of our health care system.”
Dr. Carl Amrhein
The current government has publicly expressed a commitment to build the primary health care system on the foundation of PCNs with more collaborative decision making between government and PCNs (the Joint Venture partners). This will help:
To strengthen PCNs as the vehicle for delivering primary care in Alberta.
To increase the ability of PCNs to make collective commitments.
To allow PCNs to be proactive instead of reactive.

5. Future State Minister 42 Grants/ Funding Deputy Minister
Primary Care Networks Provincial Committee
North
Primary Care Networks
Edmonton
Central
Calgary
South
Zone Committee
Zone
Committee
AH – Carl Amrhein
AHS – Verna Yiu
AMA – Mike Gormley
PCN Physician Lead Executive
The big picture goal for the health system is to provide the right care, in the right place, at the right time, by the right health professionals with access to the right information and support. Delivering on this goal will lead to more integrated care and service provision for the communities that we serve.
With the ratification of the AMA Amending Agreement, the AMA and AH have agreed to collaboratively (including AHS and PCN member Physicians) pursue a new governance structure for PCNs.
The proposed governance framework creates strong opportunities for Alberta Primary Care Networks.
A three-level governance structure; provincial, zonal and local has been proposed. All five zones are currently meeting regularly, but the new framework will formalize these relationships, driving collaborative priority setting with clearer roles and accountability.

6. Primary Care Networks Provincial Committee Roles and Reponsibilities
Future State
Primary Care Networks Provincial Committee
Membership
Five PCN Physician Leads Executive
Five AHS Senior Zone Leads
AHS Provincial Primary Health Care Representatives
Four Alberta Health Representatives (ADM Chair)
Roles and Reponsibilities
Strategic Directions
Governance/Leadership
Policy Framework
Organizational structure
Measurement and Evaluation
Funding Policy
The PCN Provincial Committee roles and responsibilities will be: strategic direction, governance/leadership, policy framework, organizational structure, measurement and evaluation, and funding policy.
For more details, please see the draft Terms of Reference.

7. Roles and Responsibilities
Future State
PCN Zone Committees
Membership
PCN Physician Lead
AHS Senior Zone Lead
Community/patient representative
Partners from other organizations as defined by the zone
Roles and Responsibilities
Advice
Planning zone-wide
Communicate bi-directionally
The PCN Zone Committees will report, inform and provide advice to the provincial committee.
The Committee will create a zone-wide service plan that provides direction to the individual PCN business plans within the zone.
The Committee will communicate, bi-directionally, provincial strategic directions and local needs and considerations by establishing meetings between the AHS zone administrative and medical leads and the zone PCN physician lead to report progress on issues to the provincial PCN Committee and other relevant groups and committees within AHS and PCNs.
A number of the zones have already informally established zone-based councils that are at different stages of maturity.

8. Committees Provincial Local PCNs
Communicates with zonal committee.
Aligns local issues.
Provincial
PCNs, Alberta Health Services and Alberta Health
Implement and oversee the PCN Framework.
Lead and support the evolving organizational structure.
Zonal
PCNs and Alberta Health Services
Reports to provincial committee.
Advocates for local issues.
The objectives for the new PCN Governance Framework are:
To create accountable governance and operations policies for local levels;
To have shared decision making and efficient policy implementation;
To allow for clearer lines of communication and feedback that is bi-directional (e.g., information will flow up from PCNs, to zone committee(s), to the provincial committee and vice versa.);
To create a framework that provides a forum for testing and challenging policy and innovation.

9. Impact What will Change? What will not Change?
Zonal and Provincial committees.
NPCs as a legal entity.
Stakeholders at the committee levels.
Legal Models.
Reporting structure.
Joint Venture Agreement.
Movement toward equitable support for vulnerable populations
The number of PCNs in the province.
Influence.
Physician Leads represented at the zonal level.
Under the Proposed Governance Framework:
What will Change?
Provincial and Zonal committees are formalized
Stakeholders at the committee levels - Physicians, AHS, AH, and AMA on committees
Reporting structure - The Zonal committees will report to and inform the Provincial committee
Movement toward equitable support for vulnerable populations
Influence - Increased influence to inform policy at the provincial level
What will not Change?
NPCs as a legal entity
Legal Models - Models 1 and 2 will remain as they are
Joint Venture Agreement – This agreement will also remain as is
The number of PCNs in the province – The number of PCNs will not be impacted (e.g. concerns raised about Super-PCNs) unless interested NPCs initiate that (e.g. mergers).

10. Considerations/Opportunities
Reduced PCN autonomy.
Strength in numbers creates a collective influence.
Perceived shift in partners influence.
Partnership already exists. There are no legal changes.
Uncertainty that funding changes may impact current programs.
Potential population-based funding models provide stability.
We are giving up PCN autonomy to some extent, but it is in exchange for great collective influence. We have a stronger voice when we ask for it collectively.
Concerns have also been raised about increased AHS influence within the new structure. AHS is a partner in all PCNs today. The new framework doesn’t change the balance of power from a legal perspective. It does bring them to the partnership table in a new way.
There will be potential to consider different funding models in order to better serve zone populations and enable an expansion of PCN services. Funding methodology may change to support the objectives of the new governance framework, however; this will be a next step and not an imminent change.

11. Alberta Health Services
Benefits
Benefits
Alberta Health
PCNs
Alberta Health Services
Reliable structure to support PMH
Equity for zones
Opportunity to standardize delivery of Primary Health Care
Active and engaged partners
Access to new supports
Having a reliable governance structure supports the implementation of the Patient’s Medical Home, but also meets the needs of PCNs and Alberta Health.
Equity for zones by identifying local concerns at the provincial table.
Opportunity to standardize delivery of Primary Health Care across the zone.
Motivates Alberta Health Services, Alberta Health and PCNs to be active and engaged partners uniformly across the Alberta.
Access to new supports and the ability to optimize existing support.

12. Possibilities The new PCN governance framework will:
Make PCNs a stronger, more consistent partner.
Make PCNs the focal point of the primary care system.
Improve equity.
Make PCNs influence and drive integration of care.
Increase the presence and involvement of physician leadership.
I think it is also important to address what happens if the vote is unsuccessful. It has been made clear that things will not remain status quo. There are several risks with the vote being unsuccessful.
There is the risk that government withdraws its support of PCNs as they remodel primary care delivery in Alberta. This does not mean that PCNs will cease to exist, but PCNs may lose their influence, relevance and seat at the table in conversations about primary health care reform.
There is a risk that new funds may not be provided such as federal funds for home care and mental health, if PCNs are not organized in this new framework.
With Physician Resource Management being a priority, there is a risk that PCNs will lose the ability to influence this resourcing process effectively.

13. Next Steps Visit: albertadoctors.org/getmyballot VOTE!
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Visit: albertadoctors.org/getmyballot
VOTE!
This is your opportunity to influence change!
Questions?
The proposed framework will need to be ratified through a double majority vote of PCNs and PCN physician members which is currently scheduled for end of May or early June 2017.
PCN Physician Leads Executive have committed to sharing information as it becomes available and will be conducting regular information sessions.
As a PCN member physician, this new structure can impact the way that PCNs move forward and scale up to support the development of a mature Medical Home that will integrate with the primary health care landscape (i.e., Health Home). It is important that you are apprised of the proposed governance changes and how they affect the foundation of the PCN.
In order to ensure your voice is heard, and as identified in the AMA Amending Agreement, it is necessary to ratify the proposed framework before we can move forward. A formal vote will occur from May 15 to June 13, 2017 at 4:30 p.m..
Ask questions! Attend information sessions and contact PCN Physician Leads Executive at
Visit: or to ensure you are receiving your electronic ballot.
VOTE! When you receive a ballot, make sure your voice is heard! This is your opportunity to influence change!