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Report

of the

Executive Director

Alberta Medical Association (CMA Alberta Division)

Date: September 4, 2019 To: Representative Forum From: Michael A. Gormley

Executive Director Subject: 2018-19 Year-End Business Plan Update For: Information

This report provides a year-end update on the 2018-19 Business Plan priority activities.

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2018-19 AMA Business Plan Year-End Update Key Result Areas, Goals and Related Activities

Key Result Area 1 - Financial Health The AMA assists and supports members in maintaining their financial health. This includes negotiating with payers to ensure fair compensation, the provision of practice management services and the offering of financial products. Members in training are supported through a number of scholarships and bursaries.

Goal 1: Physicians are fairly compensated for their skills and training in comparison to other professionals.

Activities Year-end update 1. Support the implementation of legislation to

recognize the AMA’s representation rights for all physicians.

Legislation achieved Royal Assent in December 2018 and as such is now law.

2. Negotiate on behalf of member groups for the provision of insured services. Examples include:

Represent physicians within and considering joining the Academic Medicine Health Services Program.

Alberta Health Services physician groups.

Prepare for the next round of AMA Agreement negotiations.

AMHSP

The AMHSP Council and AMA staff are preparing for negotiations with Alberta Health, AHS and the Universities regarding the AMHSP agreement that expires in March 2020. A negotiating Committee will be confirmed in fall 2019.

As of September 5, 2019, and in accordance with the AMA Strategic Agreement and the RHA Act, 13 out of 13 arrangements have over 50%+1 approval for AMA representation.

AMA Master Agreement Negotiations

The current AMA Agreement is due to be renegotiated on March 31, 2020.

The AMA’s Negotiating Committee, with board oversight, is actively preparing for these upcoming negotiations with government.

AHS Physician Groups

Negotiations are underway with several AHS physician groups, including CancerCare and Laboratory Physicians.

Discussions have started for Glenrose Geriatrics/Care of the Elderly, South Health Campus Obstetrics and Medical Officers of Health.

Increasing numbers of individual physicians continue to ask for AMA assistance in reviewing/renewing their contracts with AHS.

3. Renegotiate the Workers’ Compensation Board Agreement.

The current agreement between the WCB and the AMA has been extended to March 31, 2020. Both parties agreed to extend the agreement for a one-year period, to allow time for the parties to negotiate a new agreement. The AMA has extensively surveyed membership and has used these responses to develop our opening interest paper and proposals. Negotiation meetings are now underway.

The AMA provided negotiations support for the Alberta Orthopedic Society with the negotiation of a new orthopedic services agreement with WCB. AOS members and WCB ratified

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the resulting agreement in early August 2019. WCB is in the process of implementing the new agreement.

Goal 2: Physicians’ practice management decisions are based on sound management advice and best practice.

Activities Year-end update 1. Support appropriate member billing practices:

Implement a peer review process.

Continue to develop tools like the Fee Navigator® and billing training tools.

Peer review activities have included further review of billing outliers, section engagement and consultation, general communication (via newsletter) as well as section-specific communications.

AMA discussed with Management Committee (i.e., AH and AHS) its proposal to establish a third-party consultant for direct communication/education pieces with individual physicians. AH has agreed to explore the privacy and confidentiality considerations around this type of structure.

Fee Navigator® updates have incorporated the most recent Schedule of Medical Benefits amendments, as well as billing tips arising from peer review activities.

Billing seminar presentations have been refreshed and AMA staff are currently exploring options for remote delivery of billing education.

2. Redesign of the AMA’s integrated change management programs to support member needs.

The programs have been integrated under a new program known as the Accelerating Change Transformation Team.

Portfolios and projects are aligned and expanded to reflect the wider mandate of the ACTT program, for example, the integration portfolio with a dedicated director and resources towards integration of the health system. There are also portfolios dedicated to moving the primary care network zonal governance forward.

3. Support members under AMHSP agreements and adapt AMA governance to better recognize AMHSP physician interests.

Governance changes supported at last year’s AGM to enhance the voice of AMHSP physicians have been completed, including the creation of the AMHSP Council and the election of four AMHSP Delegates to the RF.

To represent all AMHSP physicians, the opt-in process is currently underway for AMA’s representation support for all AMHSP physicians.

The Remuneration Subcommittee has held several ‘town-hall’ meetings to engage and answer any questions from physicians that may be interested in joining the psychiatry and medical genetics plans.

Goal 3: Reliable and best-in-class financial products are available to all members

Activities Year-end update 1. Assess the implication of the sale of MD Financial

Management to Scotiabank. The AMA is working with MD Financial Management through

the financial services alliance to ensure members continue to receive the highest quality service, including a complete range of physician-centered products and advice.

AMA and CMA staff have been working closely together to implement choice on CMA membership for the fall membership

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renewal as directed by the RF.

2. Continue to offer a full suite of quality insurance products.

A full review and competitive bidding process was completed for our property and casualty insurance programs including: home; auto; commercial office; cyber liability; directors’ and officers’; and entity malpractice insurance.

Following the review we renewed contracts with TD Insurance Meloche Monnex (home and automobile) and Mardon Group Insurance (commercial products) that will ensure continued competitiveness and best-in-class service for AMA members.

A full review and competitive bidding process was completed for our proprietary group insurance plans, which include: disability; professional overhead expense; term life; critical illness; and accidental death and dismemberment. The review was completed jointly with the Doctors of BC and the Saskatchewan Medical Association.

Following the review the AMA chose to move its life, disability, professional overhead expense and critical illness group insurance plans to Manulife and its AD & D group insurance plan to Chubb. These changes will result in significant cost savings for the plans which will benefit members over the long-term.

The AMA has worked closely with the CMA in the development of a response to the federal government’s proposed changes for health and welfare trusts that could affect the AMA’s Health Benefit Trust Fund.

Key Result Area 2 – Well Being The AMA supports members in maintaining healthy work-life integration, including being a leader in the development of a comprehensive physician health program. The AMA promotes and supports physicians contributing to the broader community through activities like the AMA Youth Run Club and Emerging Leaders in Health Promotion grant program. The AMA also supports physicians in their efforts to attain safe, healthy and equitable work environments.

Goal 1: Physicians are supported in maintaining their own health and that of their families

Activities Year-end update 1. Continue to improve the quality of Physician and Family

Support Program services and monitor assistance levels.

Physician burnout education and awareness.

The PFSP continues to support the health and wellbeing of physicians, residents and medical students and their immediate families with a broad range of direct supports from education and awareness through to individual case management services.

Access to the PFSP toll-free line and to case management services shows an overall increase in number of clients again this year.

Awareness and education remain critical components of the program; annually PFSP reaches out across the province and participates in a spectrum of opportunities with various physician groups.

Interest and engagement on topical subjects such as physician burnout have been an area of focus for the program. Of interest this past year, educational sessions have evolved from creating awareness on physician burnout to

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how to mitigate the risk of burnout; a focus on educating physicians on how to be effective peer supports and new audiences have been reached, including leadership audiences. Each of these examples demonstrate slow and steady steps toward systemic improvement in support of physician health and wellness.

PFSP has also been working closely with Well Doc Alberta to ensure activities are aligned and physician needs across the wellness spectrum are met. (See below)

2. Assess opportunities to partner with the CMA to support physician health and wellbeing initiatives.

The memorandum of understanding with the CMA was signed in February. Well Doc Alberta was the first program funded under the auspices of that agreement and the AMA/CMA are considering other projects in areas of mutual interest.

Goal 2: The AMA is a broker in bringing together physicians, patients and families toward healthy communities. Physician and community contributions are supported and celebrated.

Activities Year-end update 1. Establish AMA as a key resource for bringing physicians

together with communities:

Encourage physician philanthropy and volunteerism locally, nationally and abroad through the AMA’s Community Connections™ initiative.

Continue to expand the AMA’s Youth Run Club to more schools and students.

Administer the Emerging Leaders in Health Promotion grant program.

The AMA continues to celebrate the accomplishments of members by profiling them in our publications and online. Many Hands™ and Emerging Leaders in Health Promotion will be pulled under the umbrella of the “We All Make A Difference” initiative.

YRC had programs in 402 schools with roughly 20,100 students participating and we expect more schools to get involved in the new school year.

Nine students and residents received health promotion grants.

2. Elevate the role of physicians as meaningful contributors to the community and the health care system as outlined in the AMA Member Communication Framework.

The AMA marked National Physicians’ Day on May 1 with a surrounding two week social media campaign featuring Board, Executive and RF delegates wearing buttons: We All Make A Difference. This theme will be carried forward to the new business year and expanded.

President Alison Clarke’s Shine A Light initiative, profiling the daily accomplishments of grassroots physicians, launched under the We All Make A Difference umbrella. Recipients are profiled in Alberta Doctors’ Digest and social media. Each receives a commemorative silver pin and a hand-written note from the president.

Goal 3: The AMA is committed to working with and for physicians to address system issues which impede attaining a safe, healthy equitable working environment.

Activities Year-end update 1. Working with partners through the AMA’s Diversity and

Inclusiveness Working Group, identify opportunities and possible strategies to create a more diverse, inclusive and respectful environment.

As a result of AMA consultation summits, an external leaders session and ongoing participation with other organizations through the PROactive alliance, a framework has been created to advance the co-creation of healthy working environments.

The three main dimensions are Psycho-Social Wellness and Safety, Leadership and Diversity and Inclusion.

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A Healthy Working Environments Advisory Committee has been created with an initial meeting scheduled for September 10, 2019.

2. In partnership with external organizations such as the CMA, CPSA, HQCA and AHS, develop an action plan that explores areas where burnout, disruptive behavior, organizational culture, diversity and physician leadership intersect.

In addition to the development of the framework described above, senior leaders from AMA, AHS, CMA, CMPA, CPSA, HQCA, the Faculties of Medicine at the Universities of Alberta and Calgary, The Medical Students’ Association at the two medical schools and PARA have endorsed the following statement:

We have an interest in co-creating safe, healthy, equitable and inclusive cultures where all health care team members are respected, valued, and supported fairly to achieve their full potential while improving patient outcomes/satisfaction and supporting system sustainability.

Through the PROactive alliance (AMA, AHS, CPSA, HQCA, the Faculties of Medicine at the Universities of Alberta and Calgary) an action plan has been refined with an emphasis on Year One activities that focus on: Wellness through Well Doc Alberta; leadership through a community of practice to support medical leaders and enhanced team effectiveness; and support through demonstration projects and educational offerings.

3. Work with physician groups to identify opportunities to improve physician working conditions and negotiate improvements as provided for in the Amending Agreement.

Linkages will be maintained between the consultation on Healthy Working Environments and negotiations.

The AMA is providing various groups with representation and support with AHS negotiations, which includes compensation and some working conditions.

Key Result Area 3 – System Partnership and Leadership The AMA supports members in their role as leaders within the health care system. This includes supporting physician leadership in developing innovations in care delivery and integration of primary and specialty care. Other activities include the AMA’s key role, with Alberta Health through the AMA Agreement, in developing and implementing the physician payment strategy for the province; several programs aimed at quality improvement; activities related to eHealth; and supporting the development of physician leadership skills.

Goal 1: Working with Alberta Health, Alberta Health Services and other partners, lead and influence positive change in the delivery of services.

Activities Year-end update 1. Support the continued realization of a Patient’s

Medical Home for all Albertans:

Support members, clinics and their PCNs to progressively implement elements of the PMH in their practices.

Work with AH and AHS to improve systems supports to members, clinics and their PCNs to enable the delivery of PMH to all Albertans.

Content :

Three continuity resources developed (clinical practice guideline, toolkit and webinar.)

Seven PMH podcasts developed (four currently online). Capacity:

83% of PCNs participating in an initiative to advance the PMH.

83% of PCNs use existing and new change packages.

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Accelerating Primary Care Conference event delivered November 29-30, 2018.

35 training sessions delivered.

63% of PCNs participate in at least 1/7 peer networks for change agents.

53 guidelines and tools developed (4 new in development).

Support PCN Physician Board Members:

66% of PCNs supported through attendance at strategic board planning.

104 strategic board conversations on team investment.

79 board conversations on health transformation workforce investment.

One clinic supported through change management of blended capitation practice transition.

2. Support activities that integrate care across the system:

Work with PCA and SCA as well as AHS Primary Health Care Integration Network to develop and deliver projects and services that improve the integration of care for Alberta patients.

Support immediate integration priorities such as opioid crisis response, hospital to home and PCA/SCA joint referral improvement project.

Using the negotiated agreements ability to propose changes to AMA programs, develop a proposal to evolve AMA programs to direct more engagement and support to integration activities and specialist practices.

Support the PCN physician leads executive in regular monthly meetings as well as quarterly strategic time.

Support physician leads executive to work collaboratively and strategically with Section of General Practice and Primary Care Alliance.

Member of PCN zone support teams influencing zone service planning and data utilization in population health planning.

Supporting physician leadership in Provincial PCN Committee, Coordinating Committee, Joint Venture Council, PCN zone Committees and provincial task groups, including policy.

3. Support physician members in their new roles created under the PCN Framework.

Provide physician leaders with the support to engage AHS and AH on an equal basis in the planning for new programs and activities created by the PCN framework.

Support members, clinics and PCNs in realizing new opportunities and delivering on new responsibilities created by the PCN framework.

Supporting the PCN physician leads executive in regular monthly meetings as well as quarterly strategic time.

Supporting PCN zone support teams.

Supporting physician leadership in PPCNC, Coordinating Committee, Joint Venture Council, PCN zone Committees, and others as required.

Ongoing work on a more supportive structure for the PCN physician leads executive with the changing demands with their role in zonal and provincial structure.

Goal 2: Key incentives and supports for physicians are aligned with the delivery of care and toward overall system objectives of timely access for patients to quality care.

Activities Year-end update 1. Alignment of physician compensation activities with

system objectives:

Working with sections, complete the development of an Average Net Daily Income model in support of income equity.

Work with AH and AHS to implement further AMHSP arrangements, ARPs and other alternate

A multi-year physician compensation strategy was approved by the Board of Directors in December and is in the process of being implemented.

On November 1, 2018, a new SOMB was implemented, distributing the 2017 COLA increase ($45M) negotiated under the first and second AMA Amending Agreements. Factors considered in the distribution include OH, targeted

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funding arrangements that improve the quality of care Albertans receive.

items, SAE and to partially reimburse sections for their contributions to the SOMB Savings initiative. Retroactive prorated retention benefit payments were also made to physicians.

Retroactive payments for 2017-18 and 2018-19 FFS, ARP, Business Costs Program and Rural Remote Northern Program were made to physicians in two rounds - December 2018 and May 2019. Physician On-Call payments, both retroactive and going forward - are being discussed at Physician Compensation Committee.

PCC approved a revenue-neutral list of SOMB items for October 1, 2019 implementation. A number of fee requests across multiple sections were deferred as agreement could not be reached on the changes.

Various initiatives are underway to gain a better understanding of physician equity. The most significant initiatives are concerned with assessing and measuring: physician overhead hours of work; training and career length; and market impact.

The survey results from a study performed by Deloitte to estimate physician overhead have been deemed not usable in current form by a group appointed by the Board in June. This Overhead Working Group is in the process of developing a detailed plan that can be used to determine an acceptable estimate of overhead for the profession, in the form of a model office.

An Hours of Work Study is being developed and the AMA is seeking a vendor to support this initiative.

The Training and Career Length Panel recommendations were reviewed by external consultants and will be presented to the Fall RF after final review by AMA Compensation Committee and the Board.

The AMA is working with the Institute of Health Economics on the terms of a market impact study, which is anticipated to commence in September 2019.

The AMACC has revised the dispute resolution process and revisions will be presented to the Fall 2019 RF.

The AMA and AH have revised the Data Sharing Agreement such that gender specific data can be used to help determine whether gender pay differences exist. This initiative will be done in parallel with the income equity initiative.

The AMHSP Remuneration Subcommittee has met regularly over the past year. An AMHSP Strategy including a set of principles and a process to establish remuneration rates has been developed by the subcommittee and approved by the Strategy Committee. The remuneration process has been applied to determine the compensation grids for the two most recent AMHSPs: psychiatry and medical genetics and genomics. Further work is underway to establish grids for general surgery and pediatric surgery.

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2. Support strategic and tactical initiatives that improve informational continuity and enhance information integration:

Work collaboratively with AH and others to enable the bi-directional flow of information between community-based physicians and Alberta Netcare.

Partner with AHS and others to develop bridging capabilities between physician office systems and the AHS provincial clinical information system.

Continue to advance the EMR Vendor Strategy to align priorities and address the needs of physicians.

The Community Information Integration/Central Patient Attachment Registry (CII/CPAR) is in Limited Production Rollout. Patient encounter digests and specialist consult reports are being made in Alberta Netcare and eNotifications are expected to be enabled in short order in some LPR clinics.

Collaboration with AHS and AH continues in enabling information exchange between community-based practices and AHS providers using Connect Care. The Non AHS Community Provider Advisory Group has been established for guidance, issue resolution and communications development.

The EMR Vendor Strategy committee continues to realize success in bringing all stakeholders together to work through issues, prioritize and resolve. A primary focus continues to be on ensuring uninterrupted eDelivery services resulting from CC implementation.

3. Participate in the development of a needs-based physician resource plan:

Working with AH develop a better needs-based analysis for community physician requirements.

The Physician Resource Planning Advisory Council has recently submitted an estimated range of additional physicians required for 2019-2020 to the Minister for consideration. The 596 physicians new practicing physicians is offset by an expected 332 physicians expected to leave practice in 2019-20. The net new additional physicians required to provide services in 2019-20 is 264 with an expected range between 336 and 192.

PRPAC has also commissioned the work of a Concept Paper: Primary Care Physician Census (the Census). This work is part of the commitment made by the parties as stated in Section 11 of the Memorandum of Understanding included in the AMA Agreement. The proposed Census will support physician resource planning work by filling gaps and providing accurate data to enhance the understanding of community-based physicians. The PRPAC Technical Working Group continues to define the scope and develop an implementation plan with a target of fall 2019 to administer the census.

Goal 3: Physicians and the AMA, in partnership with patients, play a leadership role in advocating and promoting a system characterized by Patients First®.

Activities Year-end update 1. Leverage the albertapatients.ca portal to include the

patients perspective and inform AMA decision making :

Explore patients’ understanding and attitude around the aspects of a high-performing health care system, as well as the optimal language and methods for dialogue and engagement.

Albertapatients.ca membership continues to grow and 1,300 Albertans have joined since the Spring RF, bringing the community to more than 9,500 at time of writing. An agenda-setting exercise is underway to identify the research that the Board would like to see to inform its efforts in the new business year. Ten sections so far have responded to an invitation and will be fielding specialty-specific questions to the community in the year ahead.

2. Support physician leadership:

Provide skill development opportunities to AMA physician leaders.

Develop a leadership framework to create physician capacity to leading system change that improves care for Albertans.

The AMA has provided eight leadership development courses to the general membership this year. The courses covered four topics: o Resolving Conflict in the Health Care Workplace o Power and Influence in the Workplace o The Spectrum of Behavior in Health Care; Communicating with

the High Conflict Personality and Resolving Disruptive Behavior.

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o Team Dynamics and Communication for Health Care Professionals.

o The AMA has also supported leadership development in the AMA Board by supporting five members of the Board to attend the CMA Leadership Conference.

Physician Leaders Network framework completed and physicians peer networks supported for PMH Champions.

3. Support and advocate for improved health care delivery for the Indigenous community. This will involve outreach to Indigenous physicians and First Nations communities, and participation in the Population and Aboriginal Health SCN.

The AMA has begun the process of relationship development with Indigenous leaders.

Committee members have met on multiple occasions with the Health Co-Management committee to discuss aspects of the AMA Indigenous policy. Dr. Cara Bablitz, the chair of the Indigenous Health Committee has accepted a position with the Indigenous and Population Health SCN.

Together, we are exploring avenues for improved primary care delivery to Indigenous communities.

To date, approximately 70% of the AMA staff have received Indigenous cultural safety training. Training dates for the remainder of AMA staff have been set.

The committee is also looking at means to provide Alberta physicians with face-to-face cultural safety training.

Healthy AMA Activities

Governance

Support the introduction of an AMHSP constituency within the RF.

Clarify the roles of regional delegates and zone medical staff associations within the AMA’s governance, and enhance the support available to regional delegates to engage their constituents.

Enhance strategic planning capabilities through a

deliberate and structured approach.

AMHSP arrangement representatives for all arrangements have been elected and AMHSP delegates were elected from their number in March.

A group of AMA and ZMSA leaders tasked with undertaking a comprehensive review presented their report to the Council of Zonal Leaders in February. The Council identified a number of opportunities to leverage experiences across zones to improve operations. The AMA is also providing strategic planning support for those ZMSAs who have requested it.

Board meetings have included focused time for ongoing strategic dialogue against a list of topics and criteria that were identified at the Board retreat.

Workforce

Redevelop AMA change management programs including the ARP PMO to better meet the needs of physicians.

Identify a sustainable AMA resourcing plan to support enhanced representation rights as contemplated under the Second Amending Agreement.

Complete a job evaluation process review and implement an organization wide staff engagement initiative.

Complete an operational review to ensure appropriate alignment and sustainability of services across the association.

Through the process made available under the AMA Agreement, Master Committee approved recommended changes to evolve the PMO into the ARP Physician Support Services, providing more direction support to physicians involved in or considering ARPs.

A resource plan for the current fiscal year was advanced and approved in the fall of 2018. Needs will be reviewed on a regular basis to ensure that resources are aligned to the new mandate and coordinated between functional areas.

TalentMap has been engaged by the AMA to complete a confidential employee engagement survey. Survey results will inform work plans for the coming year.

Reviews were completed in the areas of enterprise risk management and operational sustainability.

Financial

Sustainable operations and fully funded reserves. The Association is in good financial health and board reserves are fully

funded.

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Effective stewards of AMA Agreement funding.

Monitor the use of one-time reserves to support activity.

The AMA has satisfied all grant and reporting requirements related to AMA Agreement funding.

There have been no withdrawals from the one-time reserves beyond those budgeted for in the 18/19 business plan.

Relationships

Review the government affairs program and implement improvements.

Review the relationship with the CMA and pursue opportunities that benefit members.

The AMA is considering our government affairs programming as part of an overall approach to achieving our mission and vision of a high-performing health care system. Political advisors were retained to advise us on building relationships with all parties before and after the coming provincial election.

The MOU has been signed with the CMA and an agreement to fund Well Doc Alberta has been reached. AMA/CMA are exploring other opportunities to leverage resources made available through the MOU to benefit members.

Knowledge

Continue improving our scanning capabilities and approaches for providing the Board with greater insight.

Incorporate a more deliberate approach to assessing those changes in the environment that could have a profound impact on the role of the AMA and how it relates to members.

Continue work on the development of a comprehensive internal information management platform (COMPASS) that consolidates data across the AMA and becomes the foundation for future knowledge initiatives.

We have increased the number of face-to-face engagement opportunities with members, launched new web-based tools and are piloting innovative artificial intelligence tools to assess member sentiment.

A presentation was provided to all AMA staff regarding the role they play in in this assessment. Discussion occurs as part of the Ongoing Strategic Dialogue component of the Board meetings. Senior Leaders share updates through weekly meetings.

The AMA launched the first module of its new information system “COMPASS” including several analytical capability improvements and is now moving through a structured process to replace all modules over the next three years.

Budget year-end update

AMA Operations

Projected Actual

($ 000’s)

Budget

($ 000’s)

Projected Variance ($ 000’s)

REVENUE

- Dues 19,091 18,801 290 - Other 4,275 4,084 191

Total Revenue 23,366 22,885 481

Operating Expenditures - Executive Office 6,083 6,223 140 - Southern Alberta Office - Corporate Affairs

914 6,844

1,024 7,004

110 160

- Public Affairs 2,149 2,229 80 - Health Economics 2,476 2,476 - Professional Affairs 1,459 1,549 90 - Priority Projects 1,130 2,280 1,150

21,055 22,785 1,730

Transfer to Reserves 2,311 100 2,211

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1. We expect the total number of full practicing members to be 9,900 which is roughly 140 more than initially budgeted.

2. Operating expenditures are comprised primarily of workforce (staff and physician volunteers) and facility costs. We expect marginal savings across branches in these areas as noted above.

3. Budget provisions were made under Priority Projects to advance in key areas including:

Representation – a provision was made to support the AMA’s new representation mandates (e.g. AMSHP physicians, physician employees).

The AMA’s Healthy Working Environments framework including areas of diversity and inclusion, leadership and Psycho-Social Wellness and Safety (physician wellness).

Physician consultation – a provision was made to support physician consultation on AMA Agreement related activities (e.g., physician supply, appropriateness, billing system)

Informatics (e.g., CPAR/CII, EMR vendor strategy, Connect Care)

We expect total spending in these areas to be less than budgeted because initial work focused on planning and through new partnerships (e.g., CMA MOU) some of the financial burden was shared

Reserves

Board Reserves

Projected Actual

($ 000’s)

Budget

($ 000’s)

Projected Variance ($ 000’s)

Emergency 9,641 9,641

Capital 3,504 3,504

Strategic 1,000 1,000

14,145 14,145

AMA Contingency Reserve

Projected Actual

($ 000’s)

Budget

($ 000’s)

Projected Variance ($ 000’s)

Opening Balance 11,667 9,287 2,380

Net income 670 372 298

Operating Surplus 2,311 100 2,211

Negotiations (200) (200)

Income Equity initiative (571) (971) 400

13,877 8,588 5,289

AMA Agreement Fund

Projected Actual

($ 000’s)

Budget

($ 000’s)

Projected Variance ($ 000’s)

Opening Balance 1.673 1.600 73

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Net income 24 24

Other Agreement implementation activity

(120) (195) 75

Section Grants (308) (308)

System Integration (569) (743) 174

700 378 322

1. Board Reserves – This is the minimum reserve holdings established by the board for the specified purposes.

The board reserves are currently funded at required levels.

2. AMA Contingency Reserve – This is the reserve available to fund key activities that are cyclical or one-time in nature. The expected operating surplus for the year will be added to the contingency at years end.

3. AMA Agreement – These one-time funds were provided through the AMA Agreement and are used to support physicians’ involved in agreement related implementation activity. We expect this money to be fully consumed next year.