Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces

BC Ministry of Health

Doctors of BC

General Practice Service Committee

Five Regional Health Authorities (RHAs)

Ministry of Health oversees management of health services

Primary care teams began in 2008 as Integrated Health Networks, through RHAs and BC Medical Association

Primary Care Networks (PCNs) implemented (2018)

Policy documents development processes not standardized

Goal to transform family physician practices and primary care clinics into team-based Patient Medical Homes, linked and connected with a team-based PCN and RHA

A Medical Health Officer designated for each PCN for regional/provincial connection

Government of Alberta (Alberta Health [AH])

Alberta Health Services (AHS)

Alberta Medical Association (AMA)

Trilateral Master Agreement signed by AMA, AH and Regional Health Authorities (2003)

PCN model adopted (2005) with 80% physicians attached to PCNs (2016); most experience with PCN model

Single province-wide health authority implemented (AHS) (2009)

Policy documents developed by AH; implemented by PCNs as a condition of grant agreements

PCNs are joint ventures between family physicians and AHS, accountable to AH

PCNs funded by AH

Physicians’ practices largely use fee-for-service model

Ministry of Health (MOH)

Health Quality Ontario (HQO)

Ontario Primary Care Council (OPCC)

Local Health Integrated Networks (LHINs)

Association of Family Health Teams of Ontario (AFHTO)

Interprofessional teams in Community Health Centres for 40 years

Various primary care models introduced (2000–2010)

Interprofessional Family Health Teams (FHTs) introduced (2006)

Innovations in remuneration models such as Enhanced Fee-For-Service models, capitation models, salary models, and various incentives and bonuses

Change in government with reform to dismantle LHINs and introduce Ontario Health Teams (OHTs) (2019)

MOH implements and evaluates policy guidelines for the province

LHINs identified as catalyst for improving integration at the local level through Integrated Health Service Plans for regional governance based on provincial guidelines

MOH established HQO to evaluate Ontario health system, including primary care; external evaluations commissioned of primary care models, particularly FHTs

Policy is shifting from identifying primary care as a key enabler of integration

Ministry of Health and Social Services (MHSS) of Quebec

Health and Social Services Centres (HSSC)

Integrated Health and Social Service Centres (IHSSC)

College of Physicians of Quebec

Quebec Nurses Association

Introduction of interprofessional (physicians and nurses) Family Medicine Groups (2001)

Creation of 95 HSSC through administrative mergers of hospitals, community service centres and long-term care facilities (2004)

Creation of 22 IHSSCs through administrative mergers of HSSCs, rehabilitation centres and youth centres (2015)

Social workers introduced into Family Medicine Groups (2016)

High level policy documents developed by government and implemented by MHSS

Regional health and social service agencies, HSSCs and IHSSCs adapt policies to local context/priorities.

Regional health and social service agencies, HSSCs/IHSSCs accountable to MHSS through regular reports and data submission

Leveraging administrative mergers (HSSCs/IHSSCs) of public healthcare organisations to enhance inter-organizational connectivity through health networks.