2014-17 Multi-Sector Service Accountability Agreement (M-SAA)

An Overview

Presentation to Health Service Providers January 10, 2014

2014-17 M-SAA

An Overview

 Development and Preparation of the M-SAA  Template Agreement Components  Schedules  Indicators  Next Steps  Questions 2

• • • •

What is an M-SAA?

Core lever for HSP accountability and performance management

A tool to bring all the various contractual agreements between community HSPs and the LHINs into one document Required under LHSIA and Ministry-LHIN Performance Agreement (MLPA) A vehicle to delineate accountabilities and performance expectations A mechanism to clarify that the HSP will be responsible for performance as well as planning and integration towards the development of a health system 3

Pan-LHIN Development, Local Execution

Developing provincial templates for local execution

• • Consistent template agreement for all community sector HSPs developed through comprehensive consultation with HSP associations and member representatives (membership listed in Appendix 1) Schedules for each sub sector (CCAC, CHC, MH&A and CSS) developed through consultation with sub-sectors • Individual LHINs negotiate performance indicator targets with each HSP in alignment with pan-LHIN guidelines 4

• •

M-SAA Development Principles

Enabling close ongoing collaboration with the Community Sector

The M-SAA Advisory Committee is co-chaired by Louise Paquette and Scott McLeod and brings together senior executives from M-SAA sector associations, community HSPs and the LHINs to provide a central forum for enabling dialogue on provincial M-SAA issues The Committee is guided by the following principles: • The process is undertaken with a spirit of trust and collaboration among the province’s community HSPs, sector associations and the LHINs.

• The M-SAA will align with provincial health system priorities and be consistent with MOHLTC policy, legislation and regulations.

• The M-SAA will strive to streamline processes, minimize administrative burden and provide clarity for HSPs where possible.

• Committee membership is shown below 5

M-SAA Structure

Comprehensive Consultation through Multiple Tables

M-SAA Advisory Committee

M-SAA Indicators

Work Group

M-SAA Planning & Schedules

Work Group

M-SAA INDICATOR SUPPORT: HEALTH SYSTEM INDICATOR INITIATIVE M-SAA LEGAL COUNSEL SUPPORT: LHIN LEGAL SERVICES BRANCH M-SAA SECRETARIAT SUPPORT: LHIN COLLABORATIVE LOCAL M-SAA IMPLEMENTATION: LHIN M-SAA LEADS 6

M-SAA Advisory Committee Membership

Sector

LHIN LHIN LHIN LHIN LHIN CHC CHC CSS CSS

Organization

NE LHIN CW LHIN NE LHIN CW LHIN CW LHIN AOHC Davenport Perth Neighbourhood CHC OCSA CANES Community Care

Individual, Title

Louise Paquette, CEO Scott McLeod, CEO Kate Fyfe, Senior Director Brock Hovey, Senior Director Neil McIntosh, Director Adrianna Tetley, Executive Director Kim Fraser, Executive Director David Hughes, Director, Membership Development Gord Gunning, CEO 7

M-SAA Advisory Committee Membership

continued

Sector

CMH&A CMH&A CMH&A CCAC CCAC LTC LTC LTC LTC

Organization

Addictions & Mental Health Ontario CMHA Ontario CMHA Toronto OACCAC CE CCAC OANHSS City of Toronto OLTCA Extendicare Inc.

Individual, Title

David Kelly, Executive Director Camille Quenneville, CEO Steve Lurie, Executive Director Sharon Baker, COO Don Ford, CEO Jeff Graham, Director, Public Policy Reg Paul, General Manager, LTC Homes & Services Paula Neves, Director of Health Planning and Research Christina McKey, VP, Eastern Operations 8

LHIN/Sector Responsibilities

Advisory Committee and Work Group Mandates

 M-SAA Advisory Committee Established to provide advice to the LHIN CEOs and support for the completion of the 2014-17 M-SAA template agreement and schedules in alignment with provincial strategic directions.  M-SAA Indicators Work Group Established to support the M-SAA Advisory Committee. Based on direction from the LHIN CEOs, the Work Group is responsible for producing a series of documents and recommendations including a list of recommended M-SAA indicators, technical specifications, target setting guidelines and education materials.  M-SAA Planning & Schedules Work Group Established to support the M-SAA Advisory Committee. Based on direction from the LHIN CEOs, the Work Group is responsible for producing a series of documents and tools including M-SAA Schedules, CAPS forms and planning submission guide and educational documents.

9

LHIN/HSP Accountability Relationship

How do the various CAPS/M-SAA components fit together?

Community Accountability Planning Submission (CAPS)  Multi-sector Service Accountability Agreement (M-SAA)  Quarterly Reports [Ontario Healthcare Report Standards (MIS)]  Remediation Negotiation, Implementation of Consequences Measurement Planning Commitment Negotiations/Consultations Adjustment Negotiations 10

LHIN/Sector Responsibilities

What are the responsibilities of the LHINs and the HSPs?

• • • LHINs are responsible for: Training and supporting HSPs through the CAPS and M-SAA processes Negotiating performance targets within the context of a provincial framework Monitoring the achievement of specific performance goals under the M-SAA and ongoing performance management • • • • HSPs are responsible for: Ensuring governance and operations that support high quality care Promoting leading performance improvement approaches Providing access to high quality health services and coordinated health care in an effective and efficient manner Identifying integration opportunities and engaging the public and stakeholders in any planned service changes.

11

Process for Finalizing New M-SAA

At a high level, how was the M-SAA developed and finalized?

 LHINs revised language in the 2011-14 M-SAA that required updating or would benefit from greater clarity as a draft 2014-17 M-SAA for sector feedback.

 Three 3-hour M-SAA Advisory Committee meetings to review and discuss comments and suggestions on draft 2014-17 M-SAA.

 175 sector comments received and individually addressed.

 Committee endorsed 2014-17 M-SAA and Schedules on December 17, 2013.

 Pan-LHIN commitment to reduce, align and enhance consistency of local indicators.  Committee will continued to meet throughout the life of the agreement to advance M-SAA related priority issues. 12

M-SAA Content – Articles

Article 1 Definitions & Interpretation

Clarifies terminology used throughout the document.

Article 2 Term and Nature of the Agreement

Defines the term of the service accountability agreement as April 1, 2014 to March 31, 2017 .

Article 3 Provision of Services

Describes how services will be provided in accordance with legislation, applicable policies, e health/IT compliance and the terms of this agreement. Discusses subcontracting services and conflict of interest.

Article 4 Funding

Outlines conditions of funding, payment and provision limitations. Procurement and disposition of goods and services are also described.

Article 5 Repayment and Recovery of Funding

Defines circumstances under which funding may be adjusted and/or recovered 13

M-SAA Content - Articles

continued

Article 6 Planning & Integration

Discusses multi-year planning CAPS requirements in alignment with LHIN IHSP and priorities.

Article 7 Performance

Discusses the need for ongoing performance improvement and the mitigating process in the event of performance factors (non-performance).

Article 8 Reporting, Accounting and Review

Describes the obligations of reporting and record maintenance, French language requirements, disclosure of information, transparency and reviews.

Article 9 Acknowledgement of LHIN Support

HSP publications are required to note LHIN support, be approved by the LHIN, and indicate views do not necessarily reflect those of the LHIN or Government.

Article 10 Representations, Warranties and Covenants

Confirms the HSP’s ability to enter into the agreement and carry out the funded services with the appropriate governance, personnel and documentation.

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M-SAA Content - Articles

continued

Article 11 Limitation of Liability, Indemnity & Insurance

Outlines the limitation of liability and indemnification for the LHINs and the required insurance provisions for the HSP.

Article 12 Termination of Agreement

Describes the parameters for termination of the agreement by the LHIN and by the HSP.

Article 13 Notice

Details how notices to a party must be provided.

Article 14 Additional Provisions

Identifies additional provisions to the agreement.

Article 15 Entire Agreement

Defines the agreement as constituting the entire agreement, superseding all prior agreements.

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M-SAA Content - Schedules

Schedule

A B C D E F G

Title

Description of Services Service Plan Reports Directives, Guidelines, Policies Performance Template for Project Funding Declaration of Compliance

Description

Describes the services delivered by the HSP, client populations and geography served Describes the financial and statistical status of the HSP Identifies, describes and sets due dates for HSP reporting Identifies applicable MOHLTC policies Identifies indicators, standards and local performance requirements Template used for funding special projects Form to be completed by the HSPs Board of Directors to declare that the HSP has complied with the terms of the Agreement 16

Summary of Main Changes - Schedules

What are the key changes between current and new Schedules?

SCHEDULE Schedule A Schedule B Schedule C • DIFFERENCE None COMMENTS • Schedule B1 - Added row 2 (HBAM) and row 3 (QBP) planning targets along with their functional centres for use by CCAC’s • • Revised dates revised to reflect appropriate reporting period. Updated to reflect that Supplementary Reporting (including AAH) - Quarterly Report and Annual Reconciliation Report (ARR) will be reported through SRI • Self Reporting Initiative (SRI) has replaced the Web Enabled Reporting System (WERS) for reporting 17

Summary of Main Changes

(continued)

What are the key changes between current and new Schedules?

SCHEDULE Schedule D Schedule E • • DIFFERENCE Updated to reflect current directives, guidelines and policies • Added Guideline for Community Health Service Providers Audits and Reviews, August 2012 Added note indicating that the Community Financial policy is currently under review • See update from Indicators Work Group COMMENTS • Intended to LHINs in undertaking a transparent process in identifying and responding effectively and consistently to HSPs • Review process includes MOHLTC, LHINS and community sector representatives 18

Summary of Main Changes

(continued)

What are the key changes between current and new Schedules?

SCHEDULE Schedule F Schedule G • • DIFFERENCE Updated to reflect HSP “services” rather than “deliverables” Added Appendix 1 - Exceptions COMMENTS 19

2014 – 17 M-SAA Indicators

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Introducing the Indicators

      Health System Indicator Initiative (HSII) Schedule E Indicators Performance Standards Targets Setting Indicator Work Group Focus and Approach Summary of Indicators & Technical Specifications – – Core Indicators Community Health Centres (CHC) Indicators – – – Community Care Access Centres (CCAC) Indicators Community Service Sector (CSS) Indicators Mental Health & Addiction (MH&A) Indicators 21

Performance Indicators

Health System Indicators Initiative (HSII)

• In April 2010, the LHIN-led HSII was established to create a coordinated, system-based approach to indicator identification, development, maintenance and reporting. • Central to the mandate of HSII is the close collaboration with provincial and national partners in order to leverage their organizational expertise related to indicator development, benchmarking, data extraction, and analysis.

• The revised mandate introduced in September 2013 provides a greater focus on alignment to system priorities, advancing system performance improvement through the SAAs and other mechanisms, and enabling monitoring and reporting. 22

Performance Indicators (Schedule E)

Pan-LHIN Performance Indicators and LHIN-Specific Obligations

The Performance Schedule (Schedule E) contains the following two indicator sections:

1. Pan-LHIN Indicators

are developed through the M-SAA Indicators Work Group through HSII (core indicators are relevant to all LHINs and all community sector HSPs; sector-specific indicators are only relevant to a specified sector).

•

Performance Indicators

are measures of HSP performance for which a Performance Target is set; Technical specifications of specific Performance Indicators can be found in the “M-SAA 2014-17 Indicator Technical Specifications” document.

•

Explanatory Indicators

are measures of HSP performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the “M-SAA 2014-17 Indicator Technical Specifications” document.

2. LHIN-Specific Performance Obligations

: A section where each LHIN adds specific performance objectives and obligations for their HSPs is included. LHINs are committed to minimizing any undue burden placed on providers with respect to performance management by focusing on a limited number of outcome indicators aligned with local priorities.

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Performance Indicators

Why Performance Standards?

• All performance indicators have an associated target and standard of performance. Variance outside of the standard triggers the performance management processes in Article 7 of the M-SAA.

• The LHIN or the HSP can identify a Performance Factor that “…could or will significantly affect a party’s ability to fulfill its obligations under the Agreement.” • The identification of a Performance Factor is made formally, in writing, to the other party and will include a description of the F actor’s actual or anticipated impact and a description of any action the party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor.

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Performance Indicators

Continued

How are Indicator Targets and Corridors Determined?

• Following the submission of the CAPS, LHINs and HSPs discuss indicator targets that are appropriate to each organization and its local circumstances. Targets are expected to reflect performance and drive continuous improvement.

• To complete the targets and corridors for the performance indicators, the following principles will be employed: • • • • Where provincial targets and corridors exist, the LHINs and HSPs will take these into consideration Where appropriate, use past experience from M-SAA and MLPA indicators Incorporate analyses of historical variation to inform corridor recommendations Use % range for financial and volume indicators 25

Performance Management

How are Performance Factors Addressed?

 How a LHIN chooses to deal with an indicator outside the corridor depends on a number of factors, including: • • • • • What is the realized and/or potential impact on the clients served?

Is this the first blip on an otherwise clean performance record?

Is this a unique event and unlikely to recur?

Are other areas of the organization or other HSPs affected?

What is the LHINs confidence in the HSPs ability to manage performance going ahead?

 Depending on the above, the LHIN could choose to start with a less formal tact. The formal process is always available...and can be triggered at any point.

26

Indicator Work Group Focus & Approach

 Review current indicators and develop recommendations to reduce the number of indicators  Develop recommendations regarding the definition and target setting approach for the administrative indicator calculation  Align existing indicators with pan-LHIN imperatives 27

Core (All Sectors) Performance Indicators

 Balanced budget - Fund type 2  Proportion of budget spent on administration  Variance forecast to actual expenses   Percentage total margin Service activity by functional centre  Variance of forecasted to actual units of service  Number of individuals served  Percentage of Alternative Level of Care (ALC) days 28

Core (All Sectors) Explanatory Indicators

 Cost per individual serviced by program/service/functional centre  Cost per unit of service by functional centre  Client experience (New Category) Details: – Moved from being only an explanatory indicator – for the Mental Health and Addiction sector Indicators Work Group identified need to enhance linkage with quality and patient experience for all sectors 29

Community Care Access Centres Performance Indicators

*   Access 1: 90 th Percentile Wait Time From Hospital Discharge to Service Initiation (Hospital Clients) Access 2: 90 th Percentile Wait time from Community Setting to Community Home Care Services Percentage people registered with Health Care Connect who are referred (Retired) Details: – Reporting obligations are already in place with the Ministry 30

Community Care Access Centres Explanatory Indicators

     Access: Wait time 1. 90 th Percentile wait time from hospital discharge to service initiation (hospital clients) by population groups (short stay, short stay rehab, long-stay complex) Access: Wait time 2. 90 th percentile wait time from Community setting to community home care services by population groups (short stay acute, short stay rehab, long-stay complex) Average monthly cost per episode (adult short stay, adult long-stay complex, end of life, children medically fragile) Clients with MAPLe scores high and very high living in the community supported by CCAC (New Category) Clients placed in LTCH with MAPLe scores high and very high as a proportion of total clients placed (New Category) 31

Community Care Access Centres New Explanatory Indicators

  Clients with MAPLe scores high and very high living in the community supported by CCAC Clients placed in LTCH with MAPLe scores high and very high as a proportion of total clients placed Details: – Moved from CCAC performance indicator category – Indicators fit this category and provide valuable information about how the system is functioning and the opportunities for change – Indicators are not a good measure for performance as targets are set locally by each LHIN 32

Community Care Access Centres Developmental Indicators

* * * Percentage of clients with a new or existing pressure ulcer that failed to improve (Retired) Medication safety (Retired) Percentage of home care clients who say they have fallen in the last 90 days (Retired) Details – Indicators retired as developmental – Indicators were not identified by HQO as on the Common Quality Agenda 33

Community Support Services Explanatory Indicator

 Number of persons waiting for service (by functional centre) 34

Community Support Services Developmental Indicators

* *  Average number of days waited for first service (by functional centre) (New Category) Details: – Moved from CSS Explanatory indicator category as the data is not yet available – Move to explanatory in years 2 or 3 Repeat unscheduled emergency visits within 30 days for mental health conditions (Retired) Repeat unscheduled emergency visits within 30 days for substance abuse conditions (Retired) Details: – Indicators are difficult to measure - cannot follow clients between the hospital and the community 35

Community Health Centres Performance Indicators

 *        Cervical cancer screening Colorectal Screening rate Inter-professional diabetes care rate Influenza vaccination rate Breast cancer screening rate Periodic health exam Vacancy Rate (for NPs and Physicians) Access to primary care clinical service (New) Individuals served by functional centre (Retired) Details: – Already a Core indicator 36

Community Health Centres Explanatory Indicators

 Emergency visits best managed elsewhere (New)  Client satisfaction – Access (New)  Clinical support staff per primary care provider (New)  Cultural interpretation (New)   Exam rooms per primary care provider (New) New grads/new staff (New)  Number of new patients (New)  Non-Primary Care activities (New) 37

Community Health Centres Explanatory Indicators Cont’d

 Number of registered clients (New)  Specialized care (New)  Supervision of students (New)  Third next available appointment (New) * *  Non-insured clients (New) Repeat unscheduled emergency visits within 30 days for mental health conditions (Retired) Repeat unscheduled emergency visits within 30 days for substance abuse conditions (Retired) Details: – Data is a challenge as the cell size is small 38

Community Health Centres Developmental Indicator

 CHC clients hospitalized for Ambulatory Care sensitive conditions 39

Community Mental Health & Addiction Explanatory Indicators

 Number of days waited from referral/application to initial assessment complete  Average number of days waited from initial assessment complete to service initiation  Repeat unscheduled emergency visits within 30 days * for mental health conditions (New Category)  Repeat unscheduled emergency visits within 30 days for substance abuse conditions (New Category) Details: Moved to Explanatory indicator Client experience (Retired) Details: Moved to Core indicator 40

Community Mental Health & Addiction Developmental Indicator

 OCAN/GAIN Indicator 41

Next Steps

What are the work streams and key dates?

The LHINs are working collaboratively with their HSPs to finalize M-SAAs by March 31, 2014. No v 15 CAPS Submitted to the LHIN CAPS Reviewed and Adopted by the LHIN Local M-SAA Orientation for HSPs CW LHIN Board to Approve M-SAA Template CW LHIN to prepare M-SAA Schedules LHIN to meet with HSP's to negotiate performance expectations LHINs to Prepare M-SAAs LHIN to distribute Final M-SAAs to HSPs HSP Board Approval of M-SAAs LHIN Board Approval of M-SAAs (by Mar 31) Post M-SAAs to Websites Nov Dec 75% complete Jan 10 Jan 22 Jan 14 - 28 Jan 28 Jan Feb 14 Feb 15–28 Feb Mar 5 Mar 31 Mar 31 Mar April 10 Apr 42

Questions?

Comments?

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APPENDIX 1: M-SAA Planning & Schedules Work Group Membership

Sector

LHIN LHIN LHIN LHIN LHIN LHIN LHIN

Organization

CW LHIN CW LHIN CH LHIN HNHB LHIN NE LHIN SE LHIN MH LHIH

Individual, Title

Brock Hovey, Senior Director, Health System Performance Neil McIntosh, Director, Performance and Accountability Patrick Manhire, Senior Accountability Specialist Jim Borysko, Advisor ,Health System Performance Kate Fyfe, Senior Director Mike McClelland, Senior Financial Analyst Shehnaz Fakim, Senior Lead, Health System Performance Management 44

APPENDIX 1: M-SAA Planning & Schedules Work Group Membership

continued

Sector

LTC LTC CCAC

Organization

OLTCA OANHSS SE CCAC CSS CHC CMHA MOHLTC Ontario March of Dimes Brock CHC Riverside Community Counseling Services MOHLTC MOHLTC MOHLTC

Individual, Title

Paula Neves, Director of Health Planning and Research Jeffrey Graham, Director, Public Policy Carol Ravnaas, Sr. Director Strategic Partnerships & Accountability Jason Lye, Associate Director Ron Ballantyne, Executive Director Jon Thompson, Director Vanita Bhandari, Manager, Data Standards Unit , Health Data Branch Christine Brown, Team Lead, Planning & Negotiations, LLB 45

APPENDIX 1: M-SAA Indicators Work Group Membership

Sector

LHIN LHIN

Organization

NE LHIN NW LHIN LHIN LHIN LHIN LHIN LHIN LHIN MH LHIN TC LHIN NWLHIN ESC LHIN HNHB LHIN HNHB LHIN

Individual, Title

Kate Fyfe, Senior Director James Anderson, Performance and Contract Management Consultant Heather Kundapur, Senior Lead, Health System Performance Greg Stevens, Senior Consultant, Performance Management Kevin Holder, Senior Consultant, Funding & Performance Pete Crvenkovski, Director, Performance Quality and Knowledge Management Philip Christoff, Director, Quality & Risk Management Rosalind Tarrant, Director, Access to Care 46

APPENDIX 1: M-SAA Indicators Work Group Membership

continued

Sector

LHIN LHIN CSS CSS CSS CCAC CCAC CMHA

Organization

HNHB LHIN WW LHIN Cheshire London Ontario March of Dimes Dale Brain Injury Services TC CCAC OACCAC Reconnect Mental Health Services

Individual, Title

Gaya Amirthavasar, Health Information Advisor Ted Alexander, Manager, Contracts and Accountability Angela McMillan, Attendant Services Manager Lee Harding, Director, Independent Living Services Sue Hillis, Executive Director Anne Wojtak, Senior Director, Performance Management & Accountability Rod Millard, Director, Information Management Mohamed Badsha, COO 47

APPENDIX 1: M-SAA Indicators Work Group Membership

continued

Sector

CHC LTC LTC MOHLTC MOHLTC

Organization

AOHC OLTCA OANHSS MOHLTC MOHLTC

Individual, Title

Jennifer Rayner, Regional Decision Support Specialist Paula Neves, Director of Health Planning and Research Dan Buchanan, Director of Financial Policy Naomi Kasman, Senior Health Analyst, Health Analytics Branch Soma Mondal, Manager , Health Analytics Branch 48