Primary Care Payment Models in Ontario

Primary care is the first point of contact between a patient and the health care system and includes illness prevention, health promotion, diagnosis, treatment, and rehabilitation and counselling. In Ontario, primary care has evolved from a predominantly fee- for-service (FFS) system of independent physicians to more advanced group-based practices premised on patient enrolment and comprehensive care.

The different agreements address the needs of the general population as well as specific communities and populations with focused health needs while providing primary care physicians many options.

Primary Health Care Models and Programs

Enhanced Fee-For-Service Models

The Comprehensive Care Model and Family Health Group model physicians are compensated primarily through FFS but are also eligible for specific bonuses and premiums based on patient enrolment.

Comprehensive Care Model (CCM) is for solo physicians who commit to provide comprehensive primary health care and a block of after-hours services each week to their enrolled patients.

Family Health Group (FHG) is offered to groups of three or more physicians to provide comprehensive primary health care and after-hours services to their enrolled/assigned patients.

If you would like additional information about or to register into one of the Enhanced-FFS Models, please contact a program analyst at primarycareinquiries@ontario.ca.

• List of currently active Family Health Groups

Capitation Based Models

Family Health Network (FHN) and Family Health Organization (FHO) models, which have three or more physicians, are compensated primarily through capitation payments but also receive FFS payments. The physicians are also eligible for specific bonuses and premiums based on patient enrolment.

The two models offer comprehensive care during a combination of regular physician office hours and after-hours services. Information technology and preventive health care services, chronic disease management and health promotion are also integral parts of these models. The key differences of the FHO compared to the FHN include the base rate payment, associated basket of core services, and access bonus calculation.

If you would like additional information about or to register into one of the Capitation Based Models, please contact a program analyst at primarycareinquiries@ontario.ca.

• List of currently active Family Health Networks
• List of currently active Family Health Organizations

Specialized Models

There are a number of patient enrolment models that have been developed targeted to distinct population groups or geographical areas:

• GP Focused Practice: Alternative Funding Plans to focused practice general practitioners in HIV, Palliative Care, and Care of the Elderly.
• Toronto Palliative Care Associates (TPCA): developed to provide improved access for palliative patients to palliative care doctors and palliative care services in health centres, long-term care homes and in the home for Toronto area patients.
• Homeless Shelter Agreements: provides primary health care services to homeless populations in Toronto (Inner City Health Associates) and Hamilton (Shelter Health Network).

If you would like additional information about one of these Specialized Models, please contact a program analyst at primarycareinquiries@ontario.ca.

There are additional Specialized Models in Northern Ontario.

• Rural Northern Physician Group Agreement (RNPGA): First offered in 1996 to groups of physicians in a rural community with 1 to 7 physicians. This blended capitation payment model provides a broad range of core primary health care services to all residents of a community (defined geographic area). There are 38 groups serving over 65,000 patients in the most isolated northern parts of Ontario.
• Group Health Centre: a long standing interdisciplinary practice in Sault Ste. Marie.
• First Nations Agreements: (Weeneebayko Area Health Authority and Sioux Lookout Regional Physician Services): developed to provide comprehensive primary health care services to remote communities with primarily First Nations people.

If you would like additional information about one of these northern Specialized Models, please call 1-866-727-9959.