Clinical Alternative Relationship Plans (ARP)

Blended Capitation model

Blended Capitation ARP compensation is based on an annual amount per rostered patient plus a component of fee for service payment.

• Learn about the Blended Capitation Clinical ARP model
• Rates determined by patient panel complexity. Alberta Health offers financial modelling for your clinic if you are interested. Contact us at [email protected].

Establish a Clinical ARP

Establishing a Clinical ARP includes:

• developing an expression of interest
• developing an application
• developing the conditions of payment
• implementing the Clinical ARP

To establish a Clinical ARP, a physician group may work with Alberta Health and Alberta Health Services (AHS) to explore whether a Clinical ARP is an appropriate way to support the delivery of a service or program.

A Clinical ARP framework defines:

• the program parameters, which set out the general rules for all Clinical ARPs; and
• the conditions of payment for the specific Clinical ARP.

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

• Read the Clinical ARP Framework Explained document
• Read the Clinical ARP Program Parameters 2014

Initial development

The development of a Clinical ARP begins when AHS or a physician group identifies services that could benefit from a Clinical ARP, such as a service gap or existing services that struggle under the existing compensation structure.

Physicians then work with either AHS or Alberta Health to further explore whether a Clinical ARP is a good fit to meet service delivery requirements.

If the physician group and AHS determine they want to pursue a Clinical ARP, they can develop an expression of interest to give to Alberta Health for consideration.

Access to data

To develop a Clinical ARP proposal, physician groups and AHS may need access to related data, including information about the services currently provided by physicians who would become part of the Clinical ARP. A request for this data is made to Alberta Health and AHS, as applicable.

Once the required consent forms are received and approved, required information is provided throughout the development process.

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

Expression of interest

An expression of interest is a short document that informs Alberta Health and AHS that a physician group is interested in pursuing a Clinical ARP application, or expanding their current Clinical ARP.

The expression of interest 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 not meant to be an exhaustive review of the proposed program and should be clear and concise.
• Download the Expression of Interest document (PDF, 120 KB)

Application

Once the expression of interest has been accepted, the physician group must draft a Clinical ARP application. The physician group may also elect to work with Alberta Health staff or other consultants of their choosing to draft the application. For programs that will be delivered within AHS facilities, the physician group must work with AHS to draft the application.

The application includes detailed information about the goals, program services, patients, service delivery model, practice management, governance, and non-physician professional support of the Clinical ARP.

• Download the Clinical ARP application template (PDF, 427 KB)
• Read the Clinical ARP application guidelines (PDF, 936 KB)

Conditions of payment

Once the Clinical ARP application has been accepted by all stakeholders, Alberta Health staff will draft the Clinical ARP’s Conditions of Payment (CoP). The CoP is based on the information provided within the application form.

Once the CoP is agreed upon, it is sent for approval under a Ministerial Order.

Clinical ARP operations

Service event reports

Service Event Reports are submitted via H-Link, similar to fee-for-service reports. Participating physicians use their ARP Business Arrangement (BA) when submitting, and can use codes from either the SOMB or the ARP Service Code Schedule.  Participating physicians must submit Service Event Reports for the services they deliver as a condition for being paid under a clinical ARP.

Sessional invoicing

Sessional Clinical ARPs submit their claims for benefits using the service event reporting tool. A time modifier is added to the health service code that records the amount of time spent on that service in 5-minute allotments.

Program service definitions (annualized models)

In order to calculate monthly full-time equivalents (FTEs), follow the Clinical ARP’s FTE definition. The FTEs for Clinical ARPs are defined in program service hours or program service days.

• The Clinical ARP’s FTE definition is on the first page of Schedule A in the CoP.
• The FTE definition may have 2 parts:
  • the FTE definition
  • a supplementary definition that provides further detail

Reconciliation (annualized models)

Payments are reconciled against FTE reports once a year. This reconciliation is done using the amount of FTEs identified in the CoP. The reconciliation takes into account any expansion that occurred during the fiscal year.

• Read more about the FTE Reconciliation Policy

Changing Authorized Representatives

To change the authorized representative for a Clinical ARP, submit a change authorized representative letter.

• Change Authorized Representative sample letter (PDF, 18 KB)

Locum Process

Clinical ARPs also compensate for program services provided by locum physicians by completing a locum registration form.

• Download the Locum Physician Registration Letter form (PDF, 1.6 MB)

The Alberta government does not have a direct role in obtaining, compensating, or otherwise managing locum physicians. Advice may be given to authorized representatives to assist them in these activities.

A Clinical ARP needing to terminate a locum physician must submit a Locum Physician Termination letter. (PDF, 1.6 MB).