in the Current Healthcare Environment We have to shift spending to - PowerPoint PPT Presentation

Strengthening our Capacity in the Current Healthcare Environment

“We have to shift spending to where we get the highest value. Our funding models need to be updated, to accelerate the transition from a provider-centred funding model towards a patient-centred funding model, where funding is based on the services provided.” - The Honourable Deb Matthews 2

Current System Reformed System • Draw patients to • Keep patients out of hospitals hospitals • Blend of base funding and • Historical cost plus pay-by-activity inflation financing • Regional management • Managed through • Differentiation and central government specialization along with • Homogenous, all trying specialized clinics to offer all services 3

Key Drummond Recommendations Impacting BWH • Divert all patients not requiring acute care from hospitals and into a more appropriate form of care. (Recommendation 5-3) • Support a gradual shift that ensure a continuum of care and care that is community-based. (5-7) 4

Key Drummond Recommendations Impacting BWH • Use information from funding models such as the Health-Based Allocation Model (HBAM) to examine where services may not be provided equally across health regions and conduct ongoing evaluations of each Local Health Integration Network’s progress in managing high-use populations. (5-17) • Increase the use of personal support workers and integrate them into Teams with nurse practitioners, registered nurses and other staff members where appropriate to optimize patient care. (5-22) 5

Key Drummond Recommendations Impacting BWH • Local Health Integration Networks need to use funding as a lever to encourage hospitals and other health care providers to use the full scope of practice of their staff. (5-23) • Empower primary caregivers and physicians in the Family Health Teams (FHTs) or specialized clinics to play the role of “quarterback,” tracking patients as they move through the integrated health system. (5-32) 6

Key Drummond Recommendations Impacting BWH • Use data from the Health-Based Allocation Model (HBAM) system to set appropriate compensation for procedures and cease the use of average costs to set Hospital payments. (5-50) • Create a blend of activity-based funding (i.e., funding related to interventions or outcomes) and base funding managed through accountability agreements. (5-51) 7

Key Drummond Recommendations Impacting BWH • Create policies to move people away from inpatient acute care settings by shifting access to the health care system away from emergency rooms and towards community care (i.e., walk-in clinics and Family Health Teams), home care and, in some cases, long-term care. (5-52) • Encourage hospitals to specialize so all are not trying to provide all services regardless of their comparative advantages. (5-53) 8

Key Drummond Recommendations Impacting BWH • Given the burden of alternate level of care (ALC) patients on hospital capacity, hospitals must become more effective in optimizing this capacity while applying best practices in planning patient discharges. (5-54) • Use hospitalist physicians to co-ordinate inpatient care from admission to discharge. Hospitalists should work with Family Health Teams to better co-ordinate a patient’s moves through the health care continuum (acute care, rehabilitation, long-term care, community care and home care). (5-55) 9

Key Drummond Recommendations Impacting BWH • Centralize all back-office functions such as information technology, human resources, finance and procurement across the health system. (5-95) • Put a wider array of specialist services to tender based on price and quality, while remaining under the single- payer model. (5-97) 10

Funding Model - HBAM * A similar concept will be applied to Community Care Access Centres and Long-Term Care Homes, but with different grouping methodology and proportions of quality based funding. ** Year 2 and 3 quality-based procedures to be finalized 11

Pre and Post Mitigation – 11/12 Pre Mitigation Health System Funding $43,425,011 Reform (HSFR) Allocation HSFR Funding Impact -$5,996,285 Component of Overall -4.3% Funding Impact (%) Post-Mitigation Health System Funding $48,432,870 Reform (HSFR) Allocation HSFR Funding Impact -$968,426 Component of Overall -0.7% Funding Impact (%) 12

BWH Actual Expenses vs. Expected Funding 2010-11 2011-12 2012-13 Actuals Actuals Expected Expenses Acute $78,948,371 *$78,671,939 $65,958,049 CCC $13,961,673 $13,537,174 $13,114,780 ER $17,919,465 $17,941,934 $16,735,006 MH $4,910,894 $4,968,039 $4,485,281 Rehab $5,092,499 $5,514,796 $5,608,995 Total $120,832,902 $120,633,882 $105,902,111 *Note: This excludes $7.5M in PCOP growth funding. 13

Cost / Weighted Case Comparator for Large Community Hospitals Rank Facility Name Acute & Day Acute & Day Cost/Weighted Surgery with Surgery Case 2010-11 adj Direct & Weighted Cases Overhead Cost 2010-11 2010-11 1 Brantford 68,108,919 14,629 4,656 2 Markham 77,412,929 16,129 4,800 3 Oakville 130,093,246 27,004 4,818 4 Burlington 82,291,400 17,074 4,820 5 Ottawa 88,695,149 18,287 4,850 35 BWH 78,948,371 13,182 5,989 14

Balancing the Budget To achieve a balanced budget by 2013/14, we must make an estimated $5 M in adjustments to our operations. We are not alone. All hospitals in Ontario must change the way they are doing things. 15

Other Variables • LHIN Accountability Agreements • ALC Reductions • ED Wait Times • MH Readmits • Lowering Overall Readmission Rates 16

Our Journey For the last 6 years we have used three principles to establish our directions 1. High quality, safe, and reliable care 2. A trusted working environment founded on respect 3. A strong financial base to sustain our journey 17

Employee Engagement: 4 Quadrants High 2 4 ….bottom line SUSTAINABLE Focus on Results but is it SUCCESS “Driving Metrics” sustainable? Results and inspiration 1 3 …good for …going out of morale but at business… what cost? Low High Focus on Purposeful Culture “Inspiring Commitment & Reinforcing What We Stand For” 18

Our Mission Vision Values 19

Actively Advancing Our Mission 1. Patient and Family Centred Care, Patient Advocate 2. Best Practice Spotlight, Best Practice Guidelines 3. Order sets 4. Hospitalist Expansion 5. Talent/Leadership Development 6. RTC, ED PIP, Patient Flow 7. ThedaCare 8. Performance and Transformation 20

Actively Advancing Our Mission 9. Integration  Chronic Disease Management  Merger of CHIS and PROcure (TransForm)  Mental Health Redesign  Psychogeriatrics 10. More OB - Managing Obstetrical Risk Efficiently 11. Advance Practice Model 12. QIP and improving quality and patient safety  Re-invigorating Medication Reconciliation  Re-invigorating Medworxx to improve patient flow Many other initiatives that you may be involved in 21

Patient Advocate : Patient and Family Centred Care What? • Called Patient Ombudsman in some organizations Why? • Responsible for helping patients/families with concerns • Work with staff to see the issue “through the patient’s eyes” • Identify the “real” problem and mediate the solution • Responsible lead for Patient and Family Centred Care (PFCC) Benefits • Improved satisfaction and outcomes for patients/families/staff • Further integration of PFCC philosophy Current Status • Denise Dodman in role. Recruiting Patient Experience Advisors & establishing PFCC Steering Committee 22

Best Practice Spotlight (BPSO), Best Practice Guidelines (BPGs) What? • RNAO key strategy in influencing practice excellence and positive patient outcomes Why? • Ensure quality by using the most up-to-date evidence, clinical guidelines and best practices Benefits • Improved patient outcomes through consistency, efficiency and standardization of care (i.e. reducing falls; pain management; reducing pressure ulcers) Current Status • Year One of three-year partnership between BWH and RNAO • One fellowship has begun • Two corporate Best Practice Guidelines (BPG) under-way (Client Centred Care and Therapeutic Relationships) 23

Order Sets What? • Standardized patient order sets are being implemented throughout Bluewater Health for each clinical condition Why? • This project will reduce variation in care, ensure best evidence-informed practices are followed and eliminate legibility concerns Benefits • Patients benefit by getting best care and fewer medication errors. Nurses benefit by receiving standard format clear orders. Pharmacists benefit from clarity of medication and reduction in dosing errors. Physicians benefit by not having to rely on memory for each order and fewer calls to clarify orders. Current Status • Currently there are some orders sets in use, particularly ICU, but in most of the hospital the ones that exist are poor 24