Home Month and Year November 2017 The Business of Family Medicine

The Business of Family Medicine

A collaborative approach to health care

Main reception area at Advanced Primary Care located in Bridgeland.

What if Calgarians had the option of being treated at a medical clinic that focused on a collaborative team strategy with patients while achieving the best health-care outcomes, without increasing overall costs to the public system? Would people be interested?

Many are, in fact, interested and have made the choice to entrust their health-care needs to one of the handful of collaborative health clinics in the city. Jane Smyth* and her family joined Provital Health & Wellness in Marda Loop, a clinic whose website states they are dedicated to total health and wellness and are unique in that they are able to offer the time and attentive collaborative care that clients want and need.

“I initially thought about a collaborative health doctor when our family doctor retired four years ago,” says Smyth. At the time, she had two young kids and was pregnant with her third child. She found it difficult finding a family doctor that was close to home and that had a good rapport with all members of her family. “I ended up researching all the different options in Calgary and chose Provital for a few reasons: it was close to my house, my three kids are ‘free’ until the age of 18, massages are included in the cost, and I really liked the doctors.”

Being a mother with young kids can be time consuming and chaotic, so having immediate 24-7 access to a doctor (whether in person or via the telephone) has been priceless. “Same-day visits, telephone calls while on vacation and phoned-in prescriptions have been a life and time saver for us,” exclaims Smyth.

In addition to annual physical checkups that include blood work, EKG, weight/height, etc., Smyth says she and her family meets with Provital’s doctors to review all aspects of their health and set a plan for the following year. The clinic also offers massage therapists, a nutritionist and trainer.

Advanced Primary Care (APC), located in Bridgeland, opened their doors to Calgarians in January 2016 with a vision to be a catalyst for transformation of primary health-care delivery in Alberta. “We are courageously defying the way things have always been done.”

The medical team at APC explains, “Like every other family practice clinic, [we] use a mix of publicly-funded services along with uninsured services which are not covered by the provincial health-care plan. Typically, most (not all) in-person physician visits are covered by Alberta Health Care. Physicians and team members also provide care and services that are paid separately by the patient. The cost of those ‘uninsured services’ is bundled into what is referred to by the College of Physicians and Surgeons as a block fee. It is important to understand that all physicians are allowed to charge for uninsured services and can bundle these services into a block fee.”

APC further clarifies the block fee should not be considered or confused with a “membership fee.” Doctors there explain the block fee not only provides unlimited use of certain uninsured services, but ultimately allows them to work with a team to deliver what they believe is optimal care.

Following their “five pillars of care” model, APC believes they are able to address the shortfalls in patient care that have been expressed to them. Some of these shortfalls, according to APC’s medical team, include: access to care, continuity of care, comprehensive care, shared decision-making between doctor and patient, and innovative services.

Each physician at APC has a team, referred to as a TACTeam (total advanced care team), which includes a medical office assistant, registered nurse, licensed practical nurse, clinical pharmacist and lab technician. Together, the TACTeam not only supports the physician, allowing them more time with their patient, but also the patient, allowing them more access to care. The care model essentially optimizes the uninsured services.”

With regards to accountability to the patient, APC’s business is owned, operated, trained and supervised entirely by its physician owners. “The owners fundamentally ensure that the medical ethics of the practice come first. In addition, because the owners of Advanced Primary Care are physicians, we are also regulated by the College of Physicians and Surgeons of Alberta (CPSA) which have specific standards of conduct.”

But don’t just take the doctors’ word for it – what do APC’s patients have to say about the care, quality and cost versus the benefit?

Ross Marsh, an APC patient since they opened their doors in 2016, says, “What being a member of a clinic does for our family is give me peace of mind that we are getting care that is expert, unrushed and holistic. Frankly, it’s the kind of care that many of us grew up with years ago. APC’s practitioners operate on a continuum of health, not in silos, because they recognize and practice based on the understanding that health (or illness) is most often a result of interrelated factors, not isolated ones.”

Marsh also feels the focus at the clinic is not so much on treating sickness, but promoting and ensuring health. “For me, it is this holistic approach, and the fact that the doctors are not overtaxed. I think everybody wants the best possible care for their health and the health of their family, and after a number of years with a collaborative health clinic, I am convinced that this is the best way to do all that I am able for the health of my family.”

Ric Palombi and Angela Torre echo Marsh’s comments and say that in addition to having access to medical services such as family medicine, a pharmacy, a blood lab, urgent care, virtual diagnosis and a secure patient portal, they feel APC’s doctors are top quality, experienced and thorough. “We never feel rushed through any appointment and the doctors are always focused. We are able to get same-day appointments, no wait time, which keeps us on schedule, and the clinic offers comprehensive annual exams.”

APC offers seamless accurate care managed by one integrated team, including non-traditional professionals such as acupuncturists and massage therapists. Their practice includes patients of all ages, from newborns to seniors. They evaluate patients annually using validated screening methods that are appropriate for their age and life stage for preventive medicine, growth and development. “As family physicians, we truly enjoy seeing many generations together including children, parents and grandparents.”

When it comes to cost versus benefit, Palombi and Torre are confident the benefits far outweigh the costs. They feel at ease knowing APC’s medical team is always available when someone in their family gets sick. “Because appointments are very flexible and on time, we never miss more work than we have to.”

Smyth agrees entirely and says, “The services are not cheap, but for our family, well worth it.” Provital has made a huge difference for her family, not only in terms of their health, but also for their peace of mind. “If I had to make the choice again, I would.”

According to APC’s physicians, their business “is fundamentally an effort to develop a model of care that will revolutionize the delivery of primary care in Alberta. It’s a true partnership between physicians and patients. It is about defying the status quo while still protecting the tremendous value that we all receive in the Canadian health-care system and creating a financially-sustainable health-care system for generations of families to come.”