LHIN Engagement of IHFs in Planning, Coordinating and Delivering Diagnostic Services

LHIN Engagement of IHFs in Planning, Coordinating and Delivering Diagnostic Services

Presented by:Deborah Hammons, CEO Central East LHINPaul Huras, CEO South East LHINSeptember 20, 2013

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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• 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

Provincial:• 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

Patient Centred Integration &

Service Coordination

Community Engagement

Local HealthSystemPlanning

Funding & Allocation

Accountability& Performance

Monitoring

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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

Getting the most of the public’s investment in their health care system and being accountable for results.

2008/09 2009/10 2010/11 2011/12 2012/13 >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: • to co-ordinate services and interactions between different persons

and entities

• to partner with another person or entity in providing services or in

operating

• to transfer, merge or amalgamate services, operations, persons or

entities

• to start or cease providing services

• to cease to operate or to dissolve or wind up the operations of a

person or entity

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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

• Seamless flow of information that supports patient care

• A system that begins with primary care providers with an equal focus on prevention and health maintenance

• Create timely access to quality services by aligning people, processes and resources

• Elimination of wasteful and time consuming duplication

• Involvement of patients, residents, family and informal caregivers

Integration: In simple language…

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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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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 strideAs 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

LHIN Accomplishments

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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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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

And Still More

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Community Health Links

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• Keeps people healthy– Focused on prevention, promotion, and self-management– Developed strategies for priority populations

• Faster access to family health care– 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 decision-

making, 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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Minister’s Action Plan

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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

• 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 post-acute are smooth and coordinated

• 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

• 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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Pan-LHIN Health System Imperatives

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What Stakeholders Have Told UsOntario’s Action Plan is ambitious.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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

• 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 will be designed around, and accountable for system-level metrics established by the province.

• 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.

• 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.

• Leadership, governance, composition and integration initiatives will be flexible based on local need. Robust primary care participation is a critical success factor.

• 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

Health Links – Partnering for Patients

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Health Link Model: Core FeaturesAn 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 RequirementsThe 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

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.

• 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.

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Health Link Implementation – Roles

MOHLTC LHINs HEALTH LINK1. 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

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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• A focused set of indicators which are consistent across providers, are measurable, and

represent meaningful change in the sector will be needed.• With the immediate focus on high-users, the following would be expected as the short-

term indicators, with others being added over time.

Short Term IndicatorsAverage

cost per high user patient

Patient Satisfaction

% seniors/high users with primary

care provider

Continued focus on Wait Times (ED to

be revised)

HospitalALC

30 day readmissions

to hospital

Appropriate ED use

Time from referral to first home care visit

Same day/next day access

Time from referral to specialist consultation

Aspiration Metrics5 Million More Days at Home

5 Million More Years of Healthy Life

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Appendix B: Health Links Governance Structure

MOHLTC

Health Links Advisory TableMinistry, LHIN & Sector

Representatives

LHINs

Facilitation/SWAT TeamLHIN

RepresentativesMOHLTC

Representatives

Health Link 1Link Lead: TBD

Health Link 2Link Lead: TBD

Health Link 3Link Lead: TBD

Health Link …nLink Lead: TBD

Leadership

Accountability

Transparency

Excellent, High Quality, Patient-

Centred Care

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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 TogetherShould 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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LHINs are building relationships with and among our local communities, including:

– Patients– Governing bodies,– HSP executives– HSP frontline staff– Doctors

The LHINs Are Relationship Builders

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LHINs are listening to:– Local communities– HSPs and their health professionals– MOHLTC– And using this input to complement

quantitative information to make informed decisions

The LHINs Are The Listeners

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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 athttp://www.lhins.on.ca