Taber and Calgary clinics lauded for their funding models

The two health facilities operate under an alternate funding model. That means that clients pay a fee and healthcare providers will cover as many services as needed within a specific time frame, as opposed to a fee-for-service model where clients pay a price for each specific treatment.

Andrew Neuner, CEO of the HQCA, said they wanted to study this method to see how valuable it is and how viable it could be for other health providers across the province.

“I think that’s part of the issue – is there are a variety of them [funding models], and our recommendation is very much about bringing into alignment the different ways that we can approach alternate funding through a framework,” he told LNN.

“But, these two clinics have been in operation for more than 17 years, so there’s a lot of history and a lot of experience here and no one’s ever kind of looked really closely at these two clinics to determine what [we can] learn from what’s going on and [if] it’s actually providing good value.”

He explained that both clinics have an agreement with Alberta Health that gives them a “global funding for a basket of services”. They then use that to provide a multi-disciplinary team approach to providing care for a group of patients.

“In Taber, there’s just The Taber Clinic, so they look after everybody in Taber and then in Calgary, Crowfoot looks after about 25,000 patients,” he said.

Although he said these models can be expensive to operate under, they have been shown to result in major cost savings.

In 2016-2017, the practice models delivered by both clinics resulted in health system cost savings of $4.3 million (Crowfoot Village) and $7.2 million (Taber). Crowfoot has saved $57.3 million and Taber has saved $62.2 million since 2007-2008.

“These two clinics really work on a team-based approach. So, the person you might see when you go to the clinic isn’t necessarily the doctor right away. They match you up with who the most appropriate provider is, and they work together as a team and they get to know you very well because they want you as a part of their clinic throughout all of your health needs,” Neuner said.

“What we learned is that typically, these clinics, they admit to the hospital 30 percent less and even if you find yourself admitted to the hospital, you stay about 30 percent shorter time there because of the way they provide their care. So they wrap their services around the patient to make sure all of your health needs are being met, as opposed to being a very individualized, you know, activity by activity, this is more looking at you from a holistic approach and managing all of your care needs over time.”

He believes that the team-based approach used at both clinics played a major part in saving costs.

“When you know your patients well, you’re not ordering as many duplicate tests, you kind of have a plan, you’re not using emergency departments as much because you have a relationship with your clinic, you can get same day appointments to see your provider. All those factors sort of add up, so it’s not like all these savings happen in one place. It’s a combination of doing a number of things that adds up to that kind of value.”

The two clinics were chosen to be studied because, according to Neuner, they are two of the longest existing clinics working under different arrangements and the HQCA has been providing reports to them over time, much like they do for other physicians in the province.

He said the hope coming out of the report is that alternate funding models can be considered for other practices. However, he said it’s important to study what works and not rush into anything.

“What we hope is that Alberta Health will embrace the results and recommendation and that there be a framework developed that considers these particular models and there might be two or three others that would encourage other clinics and physicians throughout the province to consider practicing perhaps in a different way,” he said.

“We respect that this isn’t necessarily for everyone, but there is an opportunity here and the evidence for these two clinics is pretty compelling. You know, two clinics over ten years saving 120-million dollars is not a small sum of money.”

He said this is certainly a viable model other practices can consider and there are multiple ways to provide alternate funding or moving away from a fee-for-service model.

“Let’s find out what the best four or five best ways of doing this as opposed to let’s find 20 to 25 ways of doing it, so let’s sort of land on a few things because there are differences when you move across the province,” Neuner said.

“So, a place like Taber, the physicians also cover the emergency, they deliver babies, they participate in the hospital care whereas at Crowfoot, they don’t look after emergency departments, they are really just focused on the primary care piece. What’s being provided will look a little bit different everywhere.”

Neuner thanked both clinics for letting HQCA members study their methods. The report on both clinics can be found here.

by Justin Goulet

Taber and Calgary clinics lauded for their funding models

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