Payment Mechanisms for Providers

Calgary Health Region, Home Care Program

This home care program offers a range of services from nursing, therapy, rehabilitation to personal care. They are working on a Chronic Disease Management Initiative and have developed role algorithms and decision trees for diseases such as diabetes, hypertension, COPD, etc. Highlighted is the physician billing code under Alberta Health Care Insurance Plan for home care advice.

Physician Billing Code

Guides for Family Health Teams

This is a resource for those that have been approved to form a family health team in Ontario to guide them in creating localized plans for service. Guides include interdisciplinary provider compensation (for new health providers to the team) and physician compensation (with a good overview of the different models of compensation). http://www.health.gov.on.ca/transformation/fht/fht_guides.html

John Hopkins Adjusted Clinical Group (ACG) Case-Mix System

This is a population based risk adjustment tool developed in the U.S. The ACG System creates a common language for healthcare analysis and can be used to: predict high-risk users for inclusion in care management; determine government- or employer-budgeted payment to health plans; fairly allocate resources within programs; set capitation payments for provider groups; evaluate access to care; assess the efficiency of provider practices; and improve quality and monitor outcomes. Used by the British Columbia government. http://www.acg.jhsph.edu/

PHCO Operations Manual

This operations manual is for the use of Primary Health Care Organizations, health authorities and other health care providers interested in the set-up and management of primary health care organizations under the blended funding model in British Columbia. It contains sections on establishing a PHCO (funding); managing a patient registry, submitting claims, payment process, and resources. http://www.healthservices.gov.bc.ca/phc/phc_operations-manual.html