Medavie is hoping to show how government outsourcing to the private sector could lead to improved services in its new partnership with the New Brunswick government.
Starting January 1, Medavie Health Services took over the management of New Brunswick’s Tele-Care (811) and extramural services under a contract with the provincial government. It will also continue to run the province’s ambulance services.
CEO Bernard Lord says the takeover is in line with the work Medavie has been doing in other provinces. For example, they currently run Nova Scotia’s telecare service and part of the 911 service on Prince Edward Island. They also have ambulance operations in Ontario, Saskatchewan and Alberta. They also have projects for paramedicine in those provinces as well as in Massachusetts.
“We thought it was a good way for us to contribute to improving the well being of people in New Brunswick and consolidate those three, independent, isolated services and bring them together to provide enhanced quality services to the people of New Brunswick,” said Lord in an interview with Huddle at the end of December.
The provincial government decided to contract telecare and extramural services to Medavie to achieve several targets: increase the number of extramural visits to people’s homes; reduce the number of visits to hospital emergency rooms; and reduce the wait time between the referral for extramural care and the first home visit. They also must maintain high patient satisfaction. With New Brunswick already having a rapidly aging population, Lord says the provincial managed system wasn’t going to cut it.
“When you look at this additional demand and expectation on the system, just doing what we’re doing now collectively and what the province is doing now would not be sufficient to meet this need,” says Lord.
“Changing the system, building on the system and adding to the system is what will enable the government to make sure that these people have the service. We at Medavie have that expertise. We saw ourselves as a partner that could deliver this improved system for the patients.”
Lord says currently New Brunswick’s telecare is managed by Sykes in Ontario, while extramural care is run by the provincial health authorities (Horizon and Vitalitie Health). He says with Medavie running both of those and the ambulance services, they will be able to integrate these siloed services to work more effectively and efficiently together.
“They’re all doing good work providing care to patients,” he says, “But when you tear down the barriers between these agencies you can integrate the services and that’s how we get the synergies to enhance and provide more quality service to people where they live.”
Medavie will also be able to introduce new and updated technology to these services, Lord says.
“We want to equip the health professionals with 21st-century tools. Some of those tools they don’t have now. As an organization, Medavie has deep experience and expertise with the systems that we use,” he says. “For instance, with our ambulance networks, to know exactly where each ambulance is, how many paramedics are there, what they’re doing at every moment in time so we can better deploy the resources to meet the emergency needs and the constant needs of patients.
“Using the same type of thinking and technology with additional investments in the new system as we tear down the barriers is what’s going to help us achieve those goals.”
But what’s in this for Medavie? As a non-profit, Medavie doesn’t have any shareholders that benefit from any big bonuses or profit from this contract. The government is paying Medavie $2.6 million to cover administrative costs and $1.8 million more only if it meets its targets. Any extra money that’s not used for operations is given to the Medavie Foundation. Yet, Lord says this contract is still important for Medavie for it not only builds on its current business in New Brunswick but also allows them to see what different services can be exported to other regions.
“We also see this as a way to demonstrate what we are capable of at another level and we can take this expertise and export it to other provinces and other parts of the country to support our vision of improving the well being of Canadians,” he says. “But when we do, it may not be exported exactly the same way, because when we partner with other governments, we also adapt to their needs and adapt to their circumstances.”
When the news of the outsourcing was announced back in September, it was met with some criticism and backlash. Individuals and groups were concerned that the privatization of these services, citing that it could impact the quality and continuity of care. Some groups also expressed accountability concerns around contracting health services to a private organization.
There were also questions about why the province would contract out the services in the first place since they were highly regarded already. Also at the end of the December, Égalité Santé en français took the province to court trying to block the signing of the contract, which has yet to be made public. A judge ruled against the group.
Lord says this kind of response was expected.
“Every time we come in and we want to change the status quo, there will be some people who want to remain in the status quo for whatever reason, and that’s ok,” he says.
“But the fact there are some people who may disagree or may not completely understand everything that we’re doing gives us an opportunity to share with them what we want to do. We welcome the discussion. I don’t have any illusion that by January 1 everyone will be in agreement. That rarely happens in public discourse and public policy.”
Though the outsourcing of health services concerns some people, Lord says the practice also has a lot of support, including New Brunswick’s doctors. Working with the private sector is a practice he sees more provincial governments doing in the future. Having served as premier of the province, he knows how restrained government can be. He says private organizations like Medavie have the freedom and resources to be more nimble and innovative in ways government just can’t.
“I’m a believer that governments need to be focused on key things they can do well. At times governments are better positioned to set standards, to collect taxes and pay for the services and let other organizations that are specialized and experts deliver the services,” he says.
“That’s done throughout government and I think over time you will see more and more of this at all levels. Where governments realize they are in better positions to set the standards, set the goals and enforce the standards. Make sure the taxpayers get their value, that patients get their services and bring expert organizations to deliver the services.”
Though New Brunswick has been considered a leader in extramural care before, Lord seems confident that with Medavie at the wheel things will only improve.
“Thirty years ago, New Brunswick led the way to extramural care, bringing health professionals in the homes of individuals, rather than bring people into the hospital,” says Lord. “What we will be doing here is we’ll position New Brunswick to continue to lead in this environments by enhancing the services and integrating other services into the extramural program. This initiative positions New Brunswick in the leadership role in the sector.”