Transcript Community Engagement Practice in the LHIN Environment

LHIN Engagement of IHFs in Planning,
Coordinating and Delivering Diagnostic Services
Presented by:
Deborah Hammons, CEO Central East LHIN
Paul Huras, CEO South East LHIN
September 20, 2013
Session Objectives
• An Introduction to Ontario’s Local Health
Integration Networks;
• Health Links
• LHINs and IHFs – Working Together
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Local Health System Integration Act, 2006
(LHSIA)
“The purpose of this Act is to provide for an
integrated health system to improve the
health of Ontarians through better access
to high quality health services, coordinated
health care in local health systems and
across the province and effective and
efficient management of the health system
at the local level by local health integration
networks.” 2006, c. 4, s. 1.
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Ontario’s LHINs manage approximately
$22 Billion in Health Care Expenditures
LHIN
Provincial:
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Public and Private Hospitals
Long-Term Care Homes
CCAC
Community Mental Health and
Addictions
• Community Health Centres
• Community Support and
Service Agencies
e.g. Meals on Wheels
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OHIP & Doctors
Family Health Teams
Other Practitioners
Provincial Drug Programs
Trillium GoL / organ donations
Ontario Drug Benefit
Public Health
Private Labs
Ambulance Services
Independent Health Facilities
Provincial Networks / Programs
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The LHIN Mandate and Functions
Int
Accountability
& Performance
Monitoring
ts:
en
em
gre rse
y A ou
ilit e C
tab g th
un tin
co ecu
Ex
lan
Ac
Patient Centred
Integration &
Service
Coordination
P
ice
erv e
h S ours
alt
He e C
ed g th
rat tin
eg Set
Community Engagement
Local Health
System
Planning
Funding & Allocation
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Planning
Focus on creating an
integrated, high performing
health system that is
accessible and sustainable
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Funding & Allocation
Flow dollars to health
service providers in
an appropriate and
timely manner
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Accountability and
Performance Monitoring
2008/09
2009/10
2010/11
2011/12
2012/13
Getting the most of the
public’s investment in their
health care system and being
accountable for results.
>2013
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Community
Engagement
LHINs and Health Care Providers are required to
engage the community in establishing health care
plans
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Goals of Community Engagement
• Renew and maintain focus on the people who
use health care
• Enhance local responsiveness and accountability
• Balance priorities
• Develop system capacity and sustainability
• Build confidence in our Public Health Care
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How we Engage
• Local Advisory Teams or Collaboratives
• Board to Board
• Priority Portfolio Steering Committees, Networks and
Task Groups
• Community input into Integrated Health Service Plan
• Symposiums
• LHIN Website
• Presence at local events
• Open Board meetings
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What the LHIN means by Integration
Integration is:
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to co-ordinate services and interactions between different persons
and entities
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to partner with another person or entity in providing services or in
operating
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to transfer, merge or amalgamate services, operations, persons or
entities
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to start or cease providing services
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to cease to operate or to dissolve or wind up the operations of a
person or entity
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Integration: In simple language…
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Health system experienced as a coordinated system: People will get
the right treatment at the right time by the right provider
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Seamless flow of information that supports patient care
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A system that begins with primary care providers with an equal focus
on prevention and health maintenance
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Create timely access to quality services by aligning people,
processes and resources
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Elimination of wasteful and time consuming duplication
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Involvement of patients, residents, family and informal caregivers
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Expectations for our Health Service Providers
• Implement the directions for integration laid out in the accountability
agreements with LHINs
• Inform their Boards and engage their community of these
expectations
• Align their strategic and service planning within the overall LHIN
framework, with specific reference to the priorities identified in the
2013-2016 Integrated Health Service Plan
• Participate in LHIN planning exercises and provide the input and
necessary information for the development of LHIN plans
• Identify integration opportunities and demonstrate continuous
improvement in service integration, coordination and quality
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LHIN Accomplishments
Since 2005, LHINs have served Ontarians by bringing health
care planning and decision making to the local level – each
LHIN is just now hitting its stride
As mandated, LHINs have
• Developed local health systems plans
• Provided leadership in improving access to services by the
development of regional systems of care
• Responsibly managed the annual funding of $22B (over
20% of the Province’s budget) for local health services
providers
• Held Health Service Providers (HSPs) accountable for the
funding LHINs provide, and for improved performance
• Measured and reported on performance
• Engaged the citizens of their local communities
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LHIN Accomplishments (cont’d)
• Recognized by health care experts as the only model of
regionalization in Canada to bend the cost curve
• After years of negative margins, LHINs have achieved a balanced
hospital system
• For the first time Ontario’s health care is being measured; these
measurements are being reported to the public and used to set
performance targets; and these targets are being achieved
• Patients are waiting as much as seven months less for hips and
knees (as well as cataracts, heart procedures, cancer surgery,
etc.) – that’s seven month of less pain
• An additional 1,000,000 Ontarians are reporting access to a family
physician, and much of this is due to LHIN innovations, such as
Health Care Connect, as well as other LHIN initiatives.
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And Still More
As has occurred in no other province, LHINs have created a new
accountability and ensured alignment of Provincial, Regional and HSP
priorities
– Service Accountability Agreements (SAAs) mean that for the first
time HSPs are aligned with provincial and regional priorities
– SAAs ensure that LHINs are allocating and HSPs are expending
resources to achieve consistent improvement across the province
– SAAs ensure performance targets are set for each HSP,
performance measured, and outcomes improved
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Community Health Links
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Minister’s Action Plan
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Keeps people healthy
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– Focused on prevention, promotion, and self-management
– Developed strategies for priority populations
Faster access to family health care
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– Have built a strong primary care foundation, with broad access to specialty
and community services
Right care, right time, right place
– Focused on patient-centric delivery
– Implemented standardized system-wide approach to quality management
and improvement
– Have governance models that engage clinicians and the public in decisionmaking, enabling informed service provision that meets community needs in
a timely way
– Developed a system structure to integrate services along the continuum of
care, optimize coordination, and foster effective partnerships
– Utilized shared electronic medical records
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Pan-LHIN Health System Imperatives
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Enhancing Access to Primary Care – focused on advancing strategies to ensure
people have timely access to a primary care provider and creating enabling structures
and processes to align primary care more effectively within the overall continuum
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Enhancing Coordination & Transitions of Care for Targeted Populations –
e.g. Seniors Strategy: focus on seniors have individualized plans of care that allow them
to receive the care they need, when and where they need it; and the transitions postacute are smooth and coordinated
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Implementing Evidence Based Practice to Drive Safety - focused on high
priority safety issues that require consistent, coordinated responses to ensure that
patents are safe and that adverse events are minimized/eliminated
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Holding the Gains – focused on ensuring that new initiatives will not cause previous
gains to be eroded (e.g., ER/ALC, ER Wait Times, and access to care, coordination
amongst providers, enhanced focus on accountability)
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What Stakeholders Have Told Us
Ontario’s Action Plan is ambitious
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• Delivering on this agenda including the right care at the right time in the right
place requires that patients and providers work together more closely than they
have in the past.
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The partnership required goes far beyond a relationship between a LHIN and a hospital
or a hospitals and a CCAC; it needs to include the person at the centre, primary care
providers, and community partners.
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Primary care providers are essential to transformation, whether its taking more
responsibility for keeping people well, screening them appropriately for chronic
diseases or managing their care when they are sick.
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But it’s not only providers that are essential – patients need to be part of
transformation as they experience the system and know better than anyone where and
how the system can improve.
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Stakeholders have asked for the flexibility to deliver services differently, in a way that
best meets the needs of communities, to move resources between providers and to be
held to account for better outcomes for patients.
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There is consensus around the need for local (sub-LHIN) partnerships that would come
together to deliver better value for money, ensure higher-quality of care, and improve
access. They can also allow for deeper engagement with patients and help develop a
true patient-centred focus to the system
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An Early Focus – High Users
• The Ministry is proposing to focus on high users in the first phase of
transformation. According to ICES:
• 5% of the users (685,000 people) account for approximately $15.2 B
in health care costs, approximately 40% (2007$)
• If we could achieve a 10% reduction in the costs of the 5% highest
users we would save $1.5 B (2007$) and approximately $2 B in
2012$.
• Despite the high cost, in several cases the patient experience and
quality of care is not improving.
• Over 271,000 emergency room visits were made to Ontario hospitals
that could be treated in alternative settings (2010/11).
• Over 140,000 instances of patients being re-admitted to hospital in
Ontario within 30 days of their original discharge (2009/10).
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Strengthening Execution & Integration
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Introduce a new model of care at the clinical level where all providers in a community, including
primary care, hospital, community care, are charged with coordinating plans at the patient level.
Health Links – Partnering for Patients
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Health Links will be designed around, and accountable for system-level metrics established by
the province.
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Their initial focus will be on the high users, as we know that this segment of the population use
a disproportionate amount of care at a cost which is not sustainable, nor appropriate for their
needs.
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Health Links will be accountable to the LHINs and will initially be voluntary, beginning with those
partnerships that meet specified requirements. Over time, the entire province would be
represented.
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Leadership, governance, composition and integration initiatives will be flexible based on local
need. Robust primary care participation is a critical success factor.
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LHINs will work with providers that form the Health Link to ensure they put collaborative
initiatives in place that will allow for a measurable, positive impact on patient care:
• Improvements in care delivery (e.g. appropriate system utilization, care coordination)
• Improvements in patient experience
• Reduced costs
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Health Link Model: Core Features
An evolutionary model that will initially focus on improving patient care and outcomes for the high user
population cohort through enhanced local integration among health care providers, while delivering better
value for investments
Person-Centred
Activities centred on the needs of the high use population cohort (1-5%) with the
goal of improving their care and their experience at better value.
Local Focus
The scale is at the sub-LHIN level, defined by existing health service utilization
patterns and includes a minimum of 50,000 people.
Voluntary
Partnerships
Requires voluntary participation from providers involved in the care of high user
group, which at a minimum includes hospital, CCAC, primary care, specialists.
Health Links to put collaborative initiatives in place to improve care at lower cost.
Robust Primary
Care Participation
Requires involvement of primary care providers (all delivery models) within the
community.
Measurement and
Results
Robust information management practices required to identify and track
improvements for the high use population. Identification and tracking is a joint
responsibility of all Health Link participants.
Leadership
Leadership is required by all participants of the Health Link.
Each Health Link will have a Lead, based on their ability and capacity to engage
providers and focus activities on achieving results.
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Short-Term Mandatory Requirements
The following features must be in place to be eligible for Health Link implementation in the
short-term (November/December announcement):
1. Must be focused on, or prepared to focus on, a defined region with a minimum
population of 50,000, organized around natural health service utilization patterns.
2. Must include health care providers/organizations involved in the care of the high
use/high need population cohort, which at a minimum includes hospital, Specialists,
CCAC and primary care.
3. Member providers must already show a high degree of collaboration and must be
willing to sign written agreements formalizing their participation in the Health Link.
4. Member providers need to have the ability to identify and track the high use/high needs
population cohort (some assistance can be provided).
5. Collaborating providers include minimum of 65% (TBC) of primary care providers in the
region.
6. An identified and accepted Lead Organization in good standing as it relates to
accountability and governance.
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Health Link Implementation – Medium Term
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Following the announcement of the early adopters, the ministry would ask the LHINs to
identify the next partnerships ready to proceed, based on specific criteria.
1. Readiness Assessment
An assessment of the degree of readiness of particular provider
groupings based on their alignment/potential alignment with
essential features of the Health Link model.
2. Approval to Proceed
Based on the readiness assessment, Health Links will be awarded
and approved to proceed to the next stage of development.
3. Business Plan Development
Each approved Health Link will collaboratively develop a business
and resource plan identifying the initiatives that will be put in place.
4. Business Plan Approval
Business plans will be amended and approved, as necessary.
Resources will be assigned to each Health Link to support their
business plan commitments.
5. Accountability &
Management
Health Links will be accountable to LHINs; LHINs will manage and
provide support to each Health Link.
6. Performance Monitoring
Health Links will provide monthly reports to the LHINs on results to
date and other agreed upon updates.
7. Evaluation
Third party review of the model to inform continuous improvement.
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Health Link Implementation – Roles
MOHLTC
LHINs
HEALTH LINK
1. Readiness Assessment
Develop common
Readiness Assessment
template with LHINs.
Undertake Readiness
Assessment
Providers to participate in
Readiness Assessment, as
required.
2. Approval to Proceed
Approve Health Link
awards, based on LHIN
recommendations.
Identify and prioritize
recommendations
NA
3. Business Plan
Development
Support as necessary
Support provider groups in
business planning
Develop business and
resource plan, in
consultation with LHINs.
4. Business Plan Approval
Joint approval with LHINs
Joint approval with MOHLTC
Revise business and
resource plan, as required.
5. Funding
Funding responsibility will be based on the configuration of
the Health Link. Further work required in this area.
Accountable for proper
financial management and
results.
6. On-going support &
performance monitoring
Province-wide monitoring to
ensure strategic objectives are
being met.
LHIN-wide monitoring to
ensure operational
objectives are being met.
Implement integration
initiatives; report
performance monthly.
7. Evaluation
Fund
Contribute
Participate
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Health Link Performance Metrics
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A focused set of indicators which are consistent across providers, are measurable, and
represent meaningful change in the sector will be needed.
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With the immediate focus on high-users, the following would be expected as the shortterm indicators, with others being added over time.
Short Term Indicators
Hospital
ALC
Average cost
per high user
patient
Patient
Satisfaction
% seniors/high
users with primary
care provider
30 day
readmissions
to hospital
Appropriate
ED use
Time from
referral to first
home care visit
Continued focus on
Wait Times (ED to
be revised)
Same day/next
day access
Time from referral
to specialist
consultation
Aspiration Metrics
5 Million More Days at Home
5 Million More Years of Healthy Life
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Appendix B: Health Links Governance Structure
MOHLTC
Leadership
Health Links Advisory Table
Ministry, LHIN & Sector
Representatives
Accountability
LHINs
Facilitation/SWAT Team
LHIN
MOHLTC
Representatives
Representatives
Transparency
Excellent, High
Quality, PatientCentred Care
Health Link 1
Link Lead: TBD
Health Link 2
Link Lead: TBD
Health Link 3
Link Lead: TBD
Health Link …n
Link Lead: TBD
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LHINs and IHFs
Working Together
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How Can LHINs and IHFs Work Together
IHF’s involvement in IHSP process:
• Next IHSP 2014/5
• IHF reps need to meet with LHIN CEOs
• Get on LHIN CEOs’ radar
• Participate in community or focused
engagement
• Submit brief to LHIN
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How Can LHINs and IHFs Work Together
How can LHINs facilitate the coordination of diagnostic
services between hospitals & IHFs?:
• Need for a directory of IHFs per LHIN, including
scope of services and volumes
• LHINs could host meetings of IHF representatives
and hospital representatives
• LHIN could invite IHFs to regional hospital CEO
meetings
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How Can LHINs and IHFs Work Together
Opportunities for the involvement of IHF’s in LHIN
activities and committees:
• IHF health professionals could apply to be members of
LHINs’ HPAC
• IHF association could develop relationship with CEO
Council
• Individual IHFs could develop relationship with LHIN
CEO
• LHIN CEOs could ensure IHFs are represented on
their diagnostic planning groups, etc.
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How Can LHINs and IHFs Work Together
Rules of engagement for IHF’s to work with LHINs:
• LHINs are looking to improve access to high quality
care within the current fiscal realities
• IHFs should not be looking for more funds
• IHFs need to approach LHINs about how they can
contribute to a more integrated system and to more
effective delivery of services.
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How Can LHINs and IHFs Work Together
Should funding of IHF’s be under the auspices of LHINs?:
• The issue is not so much the funding, it is more the
accountability to the LHINs
• Accountability and Service Accountability Agreements
(SAAs) are more about alignment of priorities and not
about the heavy hand
• I think IHFs would gain more from accountability then
they would risk
• Re: funding, being accountable to LHINs, means
LHINs could flow funds to IHFs, such as from annual
community sector increases (i.e. 4% increase 2014)
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How Can LHINs and IHFs Work Together
How might Community-Based Specialty Clinics
impact IHF’s?:
• Who knows?
• IHFs might be a good model for the clinics
• We would expect specialty clinics to be
accountable to LHINs, but who knows
• We may need to wait another month or so
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How Can LHINs and IHFs Work Together
• LHINs are committed to improving access to
high quality care
• We value the role IHFs play in regional
systems of integrated care
• We are very interested in uniformly
strengthening our relationships with IHFs
• We offer to invite your representatives to
meet with the LHIN CEOs at near future
meeting
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The LHINs Are Relationship Builders
LHINs are building relationships with and
among our local communities, including:
– Patients
– Governing bodies,
– HSP executives
– HSP frontline staff
– Doctors
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The LHINs Are The Listeners
LHINs are listening to:
– Local communities
– HSPs and their health professionals
– MOHLTC
– And using this input to complement
quantitative information to make informed
decisions
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Concluding Messages
• Because of LHINs, health service providers in the province
are working towards commons goals that will improve
outcomes for patients and families.
• LHINs are well aware of the health care challenges facing
rural communities.
• We are working diligently to simultaneously improve patient
experience and health system outcomes using local
intelligence and levers for performance improvement.
• LHINs are continuing to evolve the health care system while
evolving themselves.
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Thank You
Questions?
For more information visit Ontario LHINs at
http://www.lhins.on.ca
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