Clinical Alternative Relationship Plans

A Clinical Alternative Relationship Plan (Clinical ARP) compensates physicians for providing a set of clinical services at defined facilities to a target population.

Clinical ARP models

The compensation model used for a Clinical ARP can take several forms. Three different Clinical ARP models are currently available. All 3 models compensate physicians for the provision of clinical services to a target population, based on a specified service delivery model. Compensation differs in each of the 3 models Ė

  1. Annualized model Ė compensation is based on the number of physician full-time equivalents required to deliver the clinical services within the Clinical ARP. A full-time equivalent is a time-based unit of measure (e.g., hours per year or days per year).
  2. Sessional model Ė compensation is based on an hourly rate for the delivery of clinical services.
  3. Blended Capitation model Ė compensation is based on an annual amount per rostered patient plus a component of fee for service payment.

Clinical ARP establishment process

The process to establish Clinical ARP begins with a physician group and Alberta Health Services (AHS). The physician group contacts Alberta Health Services (AHS) to explore whether a Clinical ARP is an appropriate mechanism to support the delivery of the program in question. Once both parties are satisfied a Clinical ARP is worth pursuing, they may engage the Programs Management Office (PMO) to begin the application process.

Clinical Alternative Relationship Plans (Clinical ARP) are governed by the Clinical ARP framework, which consists of 2 parts:

  1. the program parameters sets out the general rules for all Clinical ARPs, and
  2. each Clinical ARP has conditions of payment that set out the particular details of that Clinical ARP.

The Clinical ARP framework supports transparency, equity, and consistency across the Clinical ARP Program.

Establishing a Clinical ARP

Establishing a Clinical ARP consists of a number of steps including: developing an expression of interest, developing an application, developing the conditions of payment, and implementing the Clinical ARP.

Currently, there is a demonstration project for a new compensation model called Blended Capitation. The establishment process for this model is explained on the Blended Capitation Model page.

Initial development

The development of a Clinical ARP begins when AHS or a physician group identifies physician services that could benefit from being structured under a Clinical ARP. This could include a service gap or already existing services that struggle under the Compensation structure in use.

At this stage, physicians and AHS seek out the ARP PMO, an organization that will assist physicians and AHS in exploring whether a Clinical ARP may be a good fit to address the service gap or service inadequacy. The PMO can help physician groups and AHS begin exploratory work. If the physician group and AHS determine, with the assistance of the PMO, they would like to pursue a Clinical ARP, PMO staff will help them create an expression of interest.

Consent forms

Often in the development of a Clinical ARP proposal, physician groups, AHS, and the PMO need access to data, including data about the services already being provided by physicians who would become part of the Clinical ARP. They request this data from Alberta Health and AHS.

The Freedom of Information and Protection of Privacy (FOIP) Act governs the disclosure of physiciansí personal information, including their billing information. In order to adhere to the FOIP Act and other applicable laws, Alberta Health requires physicians submit consent forms that authorize Alberta Health to disclose this information to the PMO.

The consent forms may be obtained from the PMO, and once Alberta Health receives these, it will provide information as required and authorized under the consent form throughout the development process.

Expression of interest

An expression of interest is a short document that informs Alberta Health, AHS, and the Alberta Medical Association (AMA) that a physician group is interested in pursuing a Clinical ARP application, or expanding their current Clinical ARP. It includes basic information about the proposed Clinical ARP, including intended location, patients to be served, and program services to be provided. The expression of interest is intended to act as a headís up and is not intended to be an exhaustive review of the proposed program.

Application

Once the expression of interest has been accepted, the physician group and AHS will work together with the PMO and Alberta Health to draft a Clinical ARP application. The application includes detailed information about goals, program services, patients, service delivery model, practice management, governance, and non-physician professional support of the Clinical ARP.

Conditions of payment

Once the Clinical ARP application has been accepted by all stakeholders, Alberta Health staff will begin work on drafting the Clinical ARPís Conditions of Payment (CoP). The CoP will be populated based on the contents of the application form. Once the CoP is approved by all stakeholders, it will be sent to the Minister to determine whether to establish the Clinical ARPís CoP by Ministerial Order.

Clinical ARP operations

Service event reports

Service event reports can be submitted to Alberta Health via H-link in the same fashion as fee-for-service reports are submitted. Participating physicians will be required to use their ARP Business Arrangement (BA) when submitting, and can use codes from either the SOMB or the non-SOMB Schedule.

Sessional invoicing

Sessional Clinical ARPs submit their claims for benefits using the service event reporting tool by adding a time modifier to the health service code that records the amount of time spend on that service in 5 minute allotments.

Program service definitions (annualized models)

In order to calculate your monthly full-time equivalents (FTEs), you need to be aware of your Clinical ARPís FTE definition. Clinical ARPs will have an FTE definition in program service hours or program service days. You will find your Clinical ARPís FTE definition on the first page of Schedule A in your conditions of payment (CoP) MO. Your definition may have 2 parts: the FTE definition itself, and a supplementary definition that provides further detail.

Reconciliation (annualized models)

Alberta Health will reconcile payments against FTE reports once annually. This reconciliation will be done against the amount of FTEs identified in your CoP. The reconciliation will take into account any expansion that occurred during the fiscal year.

Changing Authorized Representatives

If you wish to request a change to the authorized representative for your Clinical ARP, send a Change Authorized Representative letter, using the below sample letter template, to Alberta Health.

Locum Process

Alberta Health enables Clinical ARPs to be paid for program services provided by locum physicians by completing a Locum registration form. Alberta Health does not have a direct role in obtaining, compensating, or otherwise managing locum physicians, although it may provide advice to authorized representatives to assist them in these activities.

A Clinical ARP wishing to terminate a Locum Physician must provide a Locum Physician Termination letter

Contact us

If you are interested in developing a Clinical ARP, contact us.