Improving Quality through Incentivizing the Reduction of Health - - PowerPoint PPT Presentation

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Improving Quality through Incentivizing the Reduction

• f Health Disparities: Real

World Applications

Aligning financial incentives with health disparities reduction in Ontario

Imtiaz Daniel PhD, CPA, CMA

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The Ontario Hospital System

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Population: 13,982,984 Ontario is the fourth largest province by total area of 1.1million square kms Ontario is in east-central Canada and borders the US and the Great Lakes. The 145 hospitals in Ontario are primarily publically financed from the provincial government. They privately deliver care. Funding flows from the government to 14 health regions. These health regions also have accountability agreements with relevant hospitals. 18 billion dollars goes towards the public financing of Ontario hospitals.

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Quick Facts on Ontario’s Hospital System

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Funding in the Past

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Health Service Providers received 75-90% of their funding in lump sums (global budgets)

• Few opportunities to change funding to meet

the demands of the populations being served

• Little incentive to improve performance or

quality

Source: HSFR Governance

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Excellent Care for all Act 2010

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Ontario Context: Health System Funding Reform (HSFR) Introduced in 2012

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Global Funding

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Health System Funding Reform Goals

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Reflects the needs of the community Equitable allocation of healthcare dollars Better quality care and improved outcomes Moderate spending growth to sustainable levels Adopt/learn from approaches used in other jurisdictions Phased in over time at a managed pace

HSFR’s goals and

• bjectives are translated

into activity-based funding model components

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Goals: Health System Funding Reform

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Source: HSFR Governance

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Health System Funding Reform Goal

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Source: HSFR Governance

$5.1B; 32.3% $2.4B 15.4% $8.4B 52.4%

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Activity-Based Funding (ABF) Models in Ontario

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A movement towards efficiency and hospital funding equity

Health-Based Allocation Model

• Estimates future expense based on past service levels

and efficiency

• Utilizes population and health information (e.g., age,

gender, income, population growth rates) as adjustments

• Expenses are adjusted for rurality

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Activity-Based Funding (ABF) Models in Ontario

Quality-Based Procedures

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• Clusters of patients with clinically related

diagnoses/ treatments and functional needs identified by an evidence-based framework.

• Provides opportunity for:

✓ Aligning incentives to facilitate adoption

• f best practices

✓ Appropriately reducing variation in costs and practice while improving outcomes

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Health Quality Ontario website: http://www.hqontario.ca/Quality-Improvement/Our-Programs/QBP-Connect

Source: HSFR Governance

Clinical Handbooks

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Healthcare Equity and Ontario Hospital Funding

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For HSFR Hospitals (N=75), there are some adjustments within the ABF models: ✓ Age ✓ Gender ✓ Socioeconomic Status (estimated using neighbourhood income quintiles available from Statistics Canada) ✓ Rurality There are no adjustments for globally-funded non-HSFR hospitals (N=70)

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Healthcare Equity and Ontario Hospital Funding

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Even with the adjustments within HSFR ABF formulas:

• There are known healthcare inequities that are difficult to target

using a formulaic funding approach (e.g., access to care).

• In Ontario, our Aboriginal populations (many of which are

located close to small, northern globally-funded hospitals)

• Addressing this healthcare inequity is particularly difficult due

to a complex policy environment:

• the

federal government is responsible for financing healthcare provided to Aboriginal populations

• the provincial government provide hospital care, physician

funding, and public health programs for all Canadians, including First Nations, Inuit, and Métis populations, but generally do not operate direct health services for First Nations on-reserve or for Inuit communities.

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Health Inequity in the Northern Ontario

• Populations in the north – First Nations, Metis and Inuit.

(18.3% in NW Region and 11% in NE)

• Substantial differences in the way health care is funded and

delivered for First Nations, Métis and Inuit peoples in Ontario

• Francophone populations
• More than one in five people (21.6%) in the North East

LHIN region identify French as their first official language spoken, which is more than five times the Ontario rate of 3.9%.

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Canada-wide: Income-Related Health Inequalities

• Recent report found income inequality has

widened over time in Canada for 3 health indicators

• Smoking
• COPD hospitalizations age<75
• Self-Rated Mental Health
• Inequalities are large (e.g., Smoking, Diabetes,

Self-Rated Mental Health, Mental Illness Hospitalization, Alcohol-Attributable Hospitalization, Infant Mortality)

• Health determinants primarily affect lower-

income groups (e.g., Core Housing Need, Homelessness, Household Food Insecurity)

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Ontario’s Rural Communities

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• 61 Small hospitals with less than 4,000

inpatient weighted cases.

CMA/CA Urban/ Rural Community Size Legend Large Primary Core Large Secondary Core Medium Primary Core Medium Secondary Core Small Secondary Core Small Fringe Medium Primary Core Medium Secondary Core Small Primary Core Small Secondary Core Small Fringe Strong MIZ Moderate Weak MIZ No MIZ Not CMA/CA Rural Urban CA CMA Urban Rural Urban Rural

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Funding Reform Evolution in Ontario

• A stronger focus on quality,

including targeted interventions to improve healthcare equity

• Establish a measure of health

need using stratified data by: Age • Sex • Geographic location • Income • Education • Aboriginal identity • Ethnicity/racial groups

• Leverage existing equity work

and align hospital funding and service equity strategy of underserviced populations to ensure patient/provider interactions are effective

• Establish special purpose

funding targeting limited populations where there are known inequities (e.g., Aboriginal populations)

• Consider the

implementation of innovative models of care to address inequities, including care models that integrate health and social care. Interventions should be developed in consultation with target populations

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Acknowledgements

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Contact: Imtiaz.Daniel@utoronto.ca idaniel@oha.com @Imtiaz.daniel