The Canadian healthcare structure is an excellent example of a single-payer healthcare system where the government covers basic healthcare costs for all residents.

Alberta, Canada provides a highly informative use-case to reference when discussing the benefits of such a system. It demonstrates how a socialised healthcare system can not only be highly beneficial for patients, but also a pragmatic and sustainable choice for providers as well.

The model lends itself to a broader, more collaborative, approach to patient care. In this model, sharing of patient information in a reliable, accessible and secure way is key to improving both the outcomes from patient consultations as well as ongoing outpatient care and includes patient self-management.

What can we learn from Alberta, where they have implemented successful clinical referrals and population health management systems?

The four key lessons learned from Alberta encompass how to:

  1. Put tools in the hands of clinicians to help them understand their patients as a population.
  2. Connect historically competitive organisations to achieve patient-centred collaboration.
  3. Significantly reduce waste caused by duplicate or uninformed actions.
  4. Manage patient needs in a proactive, cost-effective way.

The difficulty with episodic care and fee-for-service reimbursement is it has physicians treating sickness and symptoms, which fails to manage the overall health of patients and populations. Providers know that managing population health proactively is a superior approach to reactively treating symptoms.

However, as payment and delivery models are changing, so do risks. Under a fee-for-service system, providers bear little risk because in all ordinary cases, their care and treatment activities will be reimbursed. Under a value-based reimbursement system, providers’ compensation is not directly linked to services provided, so they take on the risk of determining the most cost-effective methods of keeping their patients healthy.

Alberta is a solid example of a healthcare system that has already encountered the challenges of transforming from a fee-for-service to a value-based reimbursement system and has executed changes that have resulted in measurable improvements in their population’s health.

In Alberta, priority of care and wait times for services are the driving factors for access to, or delivery of, care. The improvement Alberta has made has resulted in greater efficiency and availability of health data which in turn helps to support better decision-making for clinicians and improves the wait time for services for patients.

Ten years ago, Canada’s provincial payers increased the focus on effective spending and equitable resource allocation that drove the need for a population health management approach. Realising that information sharing was a necessity for coordinating care, Alberta invested in the connectivity between their isolated clinical systems, where patient data was stored. Connecting the many disparate EMRs, lab systems, and pharmacy systems not only brought together each patient’s information into a single view, but enabled seamless bi-directional information exchange so that providers could send and receive critical updates and tasks for each patient. This team care model is the underpinning for effective care coordination and population health management.

Once robust data exchange was achieved across the region, an incentive program was implemented for physicians to proactively manage the health of their patient workload. Each physician was paid a monthly bonus for each patient who met certain quality-of-care targets. These bonus payments were reinvested back into the physician’s practices to incentivise care of high needs patients and manage population health in Alberta. Physicians in the region have also employed nurse care coordinators to monitor the health and activities of their high needs patients. These nurse care coordinators use practice-level dashboards to identify which patients have care gaps, and proactively intervene with those patients to help them manage their own care needs.

The platform, which has powered the population health changes since March 2006 is called Alberta Netcare. Results were taken in June 2016 showing there are 51,000 users, including approximately 5,000 concurrent users at any given time, servicing a population of over 4.1 million people. On average, 1.9 million patient records are accessed per month via the HIE.

To learn more about Alberta Netcare and learn about the impressive results, read the white paper.