Patient’s Medical Home

Drs. Ginger Ruddy and Sarah Bates discuss the Patient’s Medical Home vision for Saskatchewan and the impact of COVID-19

The SMA recently spoke with Dr. Ginger Ruddy and Dr. Sarah Bates to discuss how the first few months of the COVID-19 pandemic have impacted primary care in Saskatchewan, the robustness of the Patient’s Medical Home (PMH) vision during a pandemic, and the opportunities to advance the PMH model in Saskatchewan. Dr. Ruddy is an assistant professor, Academic Family Medicine and chair of the Saskatchewan College of Family Physicians’ Patient’s Medical Home Committee. Dr. Bates is a family physician and assistant professor, undergraduate director, Academic Family Medicine. Drs. Ruddy and Bates have provided care following the PMH model in other jurisdictions.

The Canadian Medical Association and the College of Family Physicians of Canada heartily endorse the Patient’s Medical Home (PMH) as the future of family medicine in Canada. The PMH is a family practice considered by its patients to be the place they feel most comfortable presenting and discussing their personal and family health and medical concerns. When the PMH vision is fully realized, every family practice will offer the medical care that Canadians want – readily accessible, centred on patients’ needs, provided throughout every stage of life, and seamlessly integrated with other services in the health-care system and the community.

The COVID-19 pandemic has, out of necessity, created an environment ripe for advancing many facets of the PMH model: improved access, continuity, connected care, teambased care, funding to support system change and, most critically, patient-centeredness.

Q: The pandemic quickly changed how physicians provide care. Can you discuss some of these changes and how they are advancing the PMH model?

Dr. Ruddy: Unfortunately primary care in Saskatchewan has evolved little over the past decade. Patients’ access to family physicians and primary health-care teams was still mainly through face-to-face visits, resulting in potentially long wait times. Lack of access to a consistent family physician has often resulted in patients seeking episodic care, which sacrifices the benefits of continuity of care. The lack of any meaningful investment in primary care – including alternate payment models – has inhibited physicians’ ability to provide team-based, patient-partnered care.

In these early days of the pandemic, citizens of Saskatchewan worked together to flatten the curve, and those working in the health system – front line health-care workers, administrators and policy makers, adapted rapidly to respond to these known gaps in our primary care system. It is remarkable the breadth and pace of innovation that has taken place in such a short period of time and how aligned these efforts are with the PMH vision for primary care.

Within weeks, virtual care codes were made available to help ensure safe, accessible care for patients and safe work environments for physicians and their colleagues. This is a key aspect of the Patient’s Medical Home – that is, using technology to deliver timely, accessible care virtually. Many know that virtual care discussions and negotiations have been taking place for some time now, but in a matter of days, policy was created to respond to ensure accessible, safe care. Are these codes sufficient? No – but they’re a good start. Even though virtual visits have allowed patients to remotely access their family physicians, many physician offices are experiencing significant reductions in the volumes of activity. The College of Family Physicians of Canada has called on policy makers to shift to Blended Remuneration Models post-COVID because of these challenges. The recent, temporary Pandemic Physicians Services Agreement (PPSA) negotiated between the SHA and the SMA allowed physicians to move into a contractual agreement with the SHA and enabled continued viability for many family practices and ensure an available medical workforce in the event of pandemic surges. While the PPSA may not have been perfect, it offered flexibility and demonstrated a willingness for policy makers to explore alternate, permanent Blended Payment Models in the province – a mechanism shown to achieve better health outcomes.

The reduction of patient visit volumes has also resulted in the opportunity for a number of physicians to offer patients same day or day of choice appointments (also known as Open Access Scheduling or Advanced Access Scheduling) as the backlog of appointments has presently disappeared. Access is a pillar of the PMH and with the significant shift to virtual visits, many Saskatchewan patients are experiencing improved access to their family physician.

Q: Looking forward to a post-pandemic world, where might the PMH concept be positioned? Will the concept possibly become reality sooner rather than later?

Dr. Bates: The COVID-19 pandemic, while highlighting many of the cracks in our health-care system, has also forced a spotlight onto primary care. It has also illuminated some of the limitations in the way most primary care is delivered in Saskatchewan. Out of necessity, the pandemic has created an urgent need for physicians to manage the health needs of their patients in other ways. Many physicians, and other members of the health-care team, have risen to the challenge.

Ultimately, COVID-19 is revealing the power of a unified vision in the health system. It continues to show the necessity of stakeholder collaboration and commitment in achieving success. Working together, physicians and others are adapting to an extreme environment and putting patient needs ahead of all else. This is exactly what the PMH strives to do: create a primary care system with the patient at the center.

Transformation of Saskatchewan’s primary care system requires many things from all stakeholders: trust, financial investment, and a certain amount of risk tolerance. Our experience to date with COVID-19 has provided a foundation for creating a stronger relationship among physicians, the Ministry of Health, and the SHA. We are working well together because of a clear, common purpose: safe, accessible care for the citizens of Saskatchewan in a time of crisis. Further, the financial flexibility from the government demonstrated two things: the need for seed money to support system change and the ability of physicians to be good stewards of those funds. Finally (and without 12 months of painful calculations or pilot projects) there was a willingness to jump off the cliff together.

PMH in Saskatchewan needs these elements to move forward. The COVID-19 pandemic experience is demonstrating that health system stakeholders do indeed possess the necessary qualities: trust, flexibility, ingenuity, and a penchant for “cliff jumping.”

Overall, the pandemic has highlighted the value of the PMH. It has emphasized the need to progress toward this model. The resultant cooperation and commitment of the various stakeholders has provided a solid foundation for improvement and innovation. Ultimately, whether PMH becomes a reality for Saskatchewan citizens depends on how unified physicians and the SMA, the Ministry of Health and SHA are in working toward it.

The stage is set. The players know their roles. Now it’s time to act... Action! ◆

All Saskatchewan family physicians should take stock of how their practice aligns with the Patient’s Medical Home vision by completing the self-assessment tool and sharing results with the Saskatchewan College of Family Physicians. The College will be using the data collected to advocate for the allocation of more resources to physician practices. Physicians will be reimbursed for time spent completing the tool.

Self-assessment tool: https://patientsmedicalhome.ca/self-assess/

PMH reimbursement link: www.surveymonkey.com/r/58FCTCL)