ICES | Primary Care Models in Ontario English - page 10

Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10
Background
The dominant model of primary care across
Canada has traditionally rested on physicians
practising solo or in groups and being
reimbursed largely through fee-for-service
billing claims to provincial health plans for
eligible services. Over the past decade, many
provinces have sought to expand and improve
access to primary care, while at the same
time enhancing the quality of care provided.
1
In some provinces the focus has been on
structural changes (i.e., new payment
systems and interdisciplinary teams), while in
other provinces the changes have left existing
practitioner arrangements intact but sought
to enhance their access and capacity through
fee enhancements and other supports, such
as care coordinators.
2
At the same time,
many provinces have had Community Health
Centres (CHCs) existing alongside the
reforms taking place in the rest of primary
care delivery. CHCs are usually characterized
by community governance; a focus on
particular population needs and social
determinants of health; an expanded scope of
health promotion, outreach and community
development services; and salaried
interprofessional teams.
1
ICES
CHCs have existed in Ontario for over 40
years. A total of 73 CHCs serve approximately
357,000 people in 110 communities through­
out Ontario.
3
Like many other CHCs in
Canada, Ontario’s CHC health professionals
are reimbursed through salaried arrange­
ments and are considered employees. In
2001, the
Family Health Network (FHN)
was
introduced in Ontario. This new model of care
was based on capitation reimbursement for
physicians, blended with limited fee-for-
service payments and incentives. It required
formal rostering (enrolment) of patients with
loss of access bonus payments if patients
received primary care outside of the rostering
group; evening and weekend clinics; and a
physician on call ‘24/7’ with teletriage nurse
support. Incentives were provided for patients
seen after hours, for chronic disease
management and for achieving cumulative
practice thresholds for certain preventive
health care manoeuvres. Capitation payments
were based on the expected frequency of
office visits in each five-year age-sex group
but were not adjusted for health care needs
or social disparities. An additional monthly
payment called the comprehensive care fee
was paid per rostered patient, and most office
visits were paid at 10% of the full fee-for-
service value. The FHN model therefore
represented a blended reimbursement model
with the majority of payments based on
capitation. Another new model, the
Family
Health Group (FHG)
, was introduced in 2003.
It contained most of the same provisions as
the FHN model but retained full fee-for-
service payments, as well as the monthly
comprehensive care fee per rostered patient.
It therefore represented a blended
reimbursement model with the majority of
pay­ments based on fee for service. Whereas
the FHG model required a minimum of three
physicians, the
Comprehensive Care Model
(CCM)
had similar provisions as the FHG but
was designed for solo physicians. In 2005, two
older capitation models, the Health Service
Organization and the Primary Care Network,
were rolled into another new primary care
model, the
Family Health Organization (FHO)
.
Both older capitation models were based on
age-sex payments and were not adjusted for
health care needs or social disparities.
Shortly after establishment of the FHO model,
it was opened up to all primary care physician
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