Higgs government extends controversial extramural contract with Medavie

The Blaine Higgs government has extended the province's controversial extramural agreement with Medavie Health Services.

In November 2017, when Premier Blaine Higgs was still the Opposition leader, he vowed, if elected, to try to get out of the contract signed by the former Liberal Gallant government that critics warned was a first step toward privatization of the health-care system.

Last November, in the throne speech, the minority Progressive Conservative government promised to conduct a review of the deal that saw Medavie, a private, not-for-profit company based in Moncton, take over management of the extra-mural program and Tele-Care and merge them with Ambulance New Brunswick.

On Monday, Health Minister Ted Flemming announced the extension of the agreement, which took effect on Jan. 1, 2018.

"Based on the initial analysis of performance to date, we are confident to continue the service agreement and we will continue to monitor it," he said.

Number of visits 'stabilizing'

The number of visits made by extramural professionals dropped by 6,909 below the baseline taken prior to the start of the contract, but is "stabilizing" and will be monitored by the Department of Health, which maintains responsibility for the overall direction of the program, said Flemming.

The extramural program provides health-care services to New Brunswickers of all ages in their home, special care home or nursing home.

Preliminary data shows improvements in the other four indicators set out in the Medavie agreement, including referral-to-care time, emergency department visits per extramural program patient, referrals from primary care providers in the community, and patient satisfaction, according to the government's review.

Final 2018-19 year-end data is not yet available.

The service agreement between Extra-Mural/Ambulance New Brunswick and Medavie Health Services includes incentives and penalties related to performance.

The Department of Health has been working to integrate Ambulance New Brunswick, the extramural program and Tele-Care 811 to help manage primary health-care needs.

Richard Losier, CEO of Extra-Mural/Ambulance New Brunswick, said integration is "allowing for exciting developments, such as enhanced palliative care support and more comprehensive care for patients with complex needs."

The agreement, which was signed by the former Liberal government at the end of December 2017, is worth $74 million over 10 years, an amount that covers the cost to the province of salaries and other expenses. Extramural staff remain provincial employees under the deal.

On top of that amount, the province pays $2.6 million per year in Medavie's administration costs, and the company can earn additional performance bonuses of up to $1.8 million annually if it hits several targets.

The Gallant government had said the reason it was outsourcing was because the province's aging population will require more efficient, better-integrated home-care services that it felt only Medavie could provide.

Under the terms of the original contract, the Higgs government could have cancelled the agreement without cause — meaning for any reason — by paying Medavie a penalty of up to $1 million.

The contract also allowed the province to walk away "with cause" — and pay no penalty — if Medavie committed "a major breach," such as a "chronic failure" to fulfil the terms of the agreement.

The mandate of the publicly funded extramural program is to:

• Provide an alternative to hospital admissions.
• Facilitate early discharge from hospitals.
• Provide an alternative to, or postponement of admissions to long-term care facilities.