Refocusing health care in Alberta

Health Foundations in a Refocused Health Care System

As Alberta Health refocuses the health care system, changes are being made to how the government studies the system and makes plans for its future.

Those changes will include updating the way the province’s health foundations interact with the health care system, including the way they are governed, structures for accountability, and ensuring projects and fundraising priorities are aligned with system planning.

System Planning

Prior to refocusing, Alberta Health and Alberta Health Services (AHS) shared responsibilities for health system planning. Under the refocused system, this responsibility will fall solely under the purview of Alberta Health.

The System Planning Branch at Alberta Health is responsible for ensuring the coordination of provincial health system planning across sectors. This involves bringing together many different areas across the department and across supporting organizations.

Key areas of responsibility for the System Planning Branch include: 

• Leading strategic health system planning through the development of a province-wide system plan.
• Working with communities on innovative projects that align with improving health service delivery in the province.
• Leading specific initiatives that support system planning.
• Continually analyzing evidence and data to keep health system planning current and relevant.
• Supporting reporting and evaluation of operational services plans of health organizations to ensure they are in alignment with those of the government.
• Supporting the development of service priorities and expected outcomes for the provincial health agencies.

One major shift proposed for system planning is an update to the geographies through which health data and utilization patterns are studied across the province. More information on this update is forthcoming. 

Capital Planning

Health Capital Planning will be based on priorities identified in the Integrated Health System Plan, such as forecasted demand versus supply of health services; guiding principles such as cost-effectiveness, speed, and efficient delivery of services; and partnership opportunities with foundations, municipalities, and other stakeholders.

There is an opportunity to create strong alignment between health system planning and capital planning. Because the health system plan will be reviewed annually, it can inform and support decisions made as part of the annual capital planning process . The annual reviews will not impact multi-year projects once they are funded, instead this is to amplify a forward-looking perspective to inform future projects.

Working groups will be created to explore efficiencies in areas such as decreasing the amount of time it takes for a project to move through the capital planning process and reviewing health facility classifications to ensure common understanding.

Integrated Health System Plan

The Integrated Health System Plan is intended to be used as a resource to provide a common understanding of health system needs to inform health system planning and decision-making. It captures a range of sector and regional information to consider in health system decision-making.

• Population Health Assessment will analyze key population health needs of Albertans at a provincial and regional level.
• Current State Assessment will overlay population health and demographic analysis over the current state inventory of workforce, services and infrastructure by sector to understand current needs and gaps.
• Future State Forecast will build off current state to forecast healthcare needs and gaps at regional and provincial levels over the next 5, 10, 15+ years.

Planning and making decisions about the health system require several inputs. The Integrated Health System Plan can be used in the planning process to provide a foundation to understand health system needs.

Information Sharing

There is an opportunity to involve foundations in the planning process and to establish ongoing, collaborative communication. Alberta Health is considering formalizing a commitment to share the Integrated Health System Plan and data with health foundations in the hopes of encouraging the alignment of fundraising projects to health system priorities.

Health Foundations

In Alberta, there are 75 foundations supporting the health care system. Of those, eight were established under the Societies Act and, while they make important contributions to the healthcare system, they are not held to account by Health legislation and will not be directly affected by the changes being explored to health foundation legislation. That said, they will be affected by changes to the landscape overall.

The remaining 67 foundations have varied levels of governance based on when they were established. There are 32 foundations that were established under the Regional Health Authorities Act (RHAA), 27 that are continued from before that legislation was enacted, and there are eight that are exempt from the RHAA. Under the RHAA, established and continued foundations report to the Regional Health Authority (RHA), which is Alberta Health Services (AHS). The exempt foundations have no reporting relationship with AHS.

The Provincial Health Agencies Act (PHAA), which came into effect in June 2024, has made some changes to the RHAA but further amendments are being considered, including amendments that will have an impact on health foundations.

Foundations are an important contributor to the health system. In 2023, foundations reporting to AHS collectively raised $308 million to support health system projects and initiatives. In the last five years, donations from those foundations totaled $1.52 billion from more than 450,000 Albertans.

Refocusing

Provincial health agencies are being established for the priority areas of acute care, primary care (Primary Care Alberta), continuing care, and mental health and addictions (Recovery Alberta) and will each provide oversight and coordination of service delivery.

Health, Mental Health and Addictions, and Seniors, Community, and Social Services are working to implement the new agencies: 

• Recovery Alberta (Mental Health and Addiction Provincial Health Agency) has already been established and is operational as of Sept. 1, 2024.
• Primary Care Alberta will be established in November 2024.
• Work continues to establish the acute care and continuing care provincial health agencies.

At the conclusion of the transition, Alberta Health Services will shift from the regional health authority to a service provider operating 90+ hospitals.

Refocusing and Health Foundations

Prior to refocusing, most health foundations worked with AHS and Covenant Health. Before the government makes any changes to these structures, it is seeking public input on how health foundations should interact with the government in the future.

Alberta Health is exploring new objectives for foundations, including stronger alignment to system planning and a closer relationship to the department.

This shift will take time, but will enhance the following objectives:

• Strong relationships between foundations, Health, PHAs, and service delivery providers.
• Define alignment between foundations projects and Health’s system planning process.
• Continued commitment from Health to engage with foundations on system needs and priorities.
• Sustain donations in line with economic/population growth and consistent with historical levels of donations relative to overall Health spend.
• Increased collaboration for community efforts expanding beyond basic maintenance and supply purchases, ensuring fundraising efforts enhance health outcomes for all Albertans. 
• Maintain trust through ongoing and transparent communication.

Because AHS will soon transition from an RHA to a health service delivery provider, the legal responsibility for health foundations in a refocused system must be determined. This includes confirming how best to align the foundations’ governance with the future objectives for foundations outlined on the previous slide.

Policy objectives for this work include:

• Ensuring health foundations' fundraising priorities and initiatives align with priorities identified through Alberta Health's new approach to integrated system planning and needs assessments.
• Identifying which entity can best support improvements to the contributions foundations can make to the system (i.e., Alberta Health, one or more Provincial Health Agency, or one or more service delivery providers).
• Streamlining foundation governance to ensure all health foundations have equal oversight and accountability.

Have your Say

Alberta Health is conducting workshops with the chairs of the boards of Alberta’s health foundations to solicit their feedback on the potential for changes affecting their work. The government is also seeking feedback from the public on these decisions.

If you are a donor, a board member, or a member of the public interested in shaping the future of health foundations work in the province, you are invited to complete this online feedback form.