Innovations in Provincial and Regional Cancer Services Delivery - - PowerPoint PPT Presentation

Innovations in Provincial and Regional Cancer Services Delivery Planning in Ontario

2007 National Healthcare Leadership Conference Judy Burns, Director Regional Programs and Performance Management, Cancer Care Ontario June 12th, 2007

Agenda

• Background
• Priority Setting
• Allocation
• Contracts
• Quarterly Review Process
• Reallocation and Reconciliation
• Target Setting

Cancer Care Ontario’s Vision and Mission

• Working together to create the best

cancer system in the world

• We will improve the performance of the

cancer system by driving quality, accountability and innovation in all cancer-related services

Who we are

• An umbrella organization that steers

and coordinates Ontario’s cancer services and prevention efforts so that fewer people get cancer, and patients receive the highest quality of care.

CCO: An Independent Government Agency

• Chief advisor to the provincial government on

cancer care

• Legislative authority derived from Cancer Act,

Personal Health Information Protection Act

• Memorandum of Understanding with Ministry
• f Health and Long-Term Care
• Contract with hospitals for cancer services

What we do

• Direct $500M annually for cancer prevention,

detection and care

• Operate province-wide screening and

prevention programs

• Collect, monitor and report information about

cancer and cancer system performance

What we do

• Develop evidence-based standards and

guidelines

• Work with care providers to plan and

continually improve cancer services at a provincial level and regionally

Ontario Cancer Plan

• A roadmap for…

– Cancer Care Ontario – The Ontario Government – Ontario’s Regional Cancer Programs

• First comprehensive cancer

control plan in Canada

• Rolling 3-year plan
• Supports provincial and local

planning of cancer services

Ontario Cancer Plan Six priorities for action

1. Broaden development of provincial standards & guidelines 2. Implement Regional Cancer Programs 3. Close demand/capacity gap 4. Implement rapid access strategies 5. Invest in performance measurement & accountability 6. Advance coordination & focus of cancer research efforts in Ontario

Regional Cancer Programs

• Virtual program to link service providers,

patients and decision makers from the full spectrum of cancer care across a region

– Led by RVP – Cancer service planning – Identification of strategies to meet local needs – Facilitation of consumer involvement – Fostering professional development – Responding to performance results (including re- alignment of services)

Pay for Performance

• Use funding strategically to promote and

reward quality and results

• Pioneered by CCO in Ontario by tying quality

conditions to funding we allocate to hospitals to reduce cancer surgery wait times

• Goes beyond paying for volume or activity
• Hospitals agree to participate in key quality

initiatives

CCO Model for Driving Performance Improvement

• 1. Data/Information
• incidence, mortality, survival
• analysis
• Indicator development
• expert input
• 2. Knowledge
• clinical guidelines
• policy advice
• synthesis
• planning
• 4. Performance Management
• institutional agreements
• quarterly review
• quality - linked funding
• clinical accountability
• 3. Transfer
• publications
• practice leaders engaged
• policy advice
• public reporting

Priority Setting

• Priorities are determined annually

– Wait times – Evidence-based clinical priorities (e.g.: thoracic surgery guidelines, pathology reporting) – Provincial priorities (e.g.: colorectal cancer screening program)

• These drive the annual process for

contracts and performance management

Annual MOHLTC Submission

• May 9, 2007
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Target Setting

• Set provincial benchmarks designed to

improve performance and quality

• monitor and report to the public,

government, hospitals on performance

• Identify and recommend action
• Set annual targets for priority areas and

report on progress

Allocation: Cancer Surgery Agreement

• Identify what is a cancer surgery

procedure

– Index procedure list developed and reviewed annually

• Establish baseline volume – what

volume would be done without incremental funding

• Calculation of funding rates – done in

conjunction with the JPPC and based

• n actual 05/06 OCCI data

Volume Allocation

• Principles developed

– Address population based utilization through high level LHIN distribution – Allocate more lower intensity cases to community hosp and more higher intensity cases to academic centres – Proven ability to perform incremental cases – Critical mass – Minimum allocation to support real change – Consideration of wait times and capacity

Volume Allocation

• Allocations supported implementation of

surgical standards

• Review of performance
• Regional Vice President (RVP) input
• Distribution of contracts

Contracts

Purpose is to clearly lay out the roles and

• bligations of all parties:
• Volume
• Funding
• Performance requirements
• Management of performance

– Quarterly reviews – Reconciliation – Funding adjustments – Quality and reporting requirements

Contracts

• Specific requirements are laid out in

schedules

– Base and incremental volumes and funding – Quality related requirements – Reporting requirements

Quarterly Reporting

• Key process in driving accountability

and improving performance

• Provide a focus for accountability
• Designed to be efficient for CCO and

regions to administer – minimize duplication

• Performance management not limited to

quarterly reviews – continuous attention required

Second Quarter

• Review majority of performance measures
• Identify in-year volume and funding adjustments
• Volume and wait time indicators (radiation, systemic,

surgery, colonoscopy)

• Qualitative indicators (surgical oncology program)
• Information system status
• finance

Second Quarter

• Internal review with all CCO

stakeholders

• Joint review meeting with ICP and CCO

leadership teams

• Focused agenda
• Action items identified

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C1R data as of Feb 19, 2007 WT data as of May 2, 2007

C1R Volumes FY 2005 vs FY 2006 April - January

500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 5,500 6,000 6,500 7,000 7,500 8,000 8,500 12 11 10 9 8 7 6 5 4 3 2 1 Pr

LHIN # of New Cases

29,000 29,500 30,000 30,500 31,000 31,500 32,000 32,500 Scale refers to Provincial Volumes Only

C1S Volumes FY 2005 vs FY 2006 April - January

500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 5,500 6,000 6,500 12 11 10 9 8 7 6 5 4 3 2 1 Pr LH IN

# of New Cases

23,000 24,000 25,000 26,000 27,000 28,000 29,000 30,000 April - January 2006 Target Total for April - January 2006 Total for April - January 2005 Scale refers to Provincial Volumes Only

Systemic Therapy Median Wait Time Targets for FY 2006-07

1 2 3 4 5 6 7

12 11 10 9 8 7 6 5 4 3 2 1 Pr LHIN Weeks

Target for 2006/07 06/07 April to January 2007 05/06 April-January 2006

4.0

Provincial Target

Radiation Therapy Median Wait Time Targets for FY 2006-07

1 2 3 4 5 6 7 8 9 10

12 11 10 9 8 7 6 5 4 3 2 1 Pr LHIN Weeks 3.4

Provincial Target

Third Quarter

• Volume projections for year-end and

next fiscal year

• Regional plans – regional cancer

program, screening and prevention

• ICP Contract review – any outstanding

issues

• Teleconference held with CCO VP,

Director and Regional Vice President

Fourth Quarter

• Review of exception-based issues for

volume measures (i.e.: only if problem exists)

• Detailed review of progress against all
• ther performance measures
• Internal review
• Joint review with host hospital, ICP and

CCO leadership

Reallocation and Reconciliation

• Provides CCO with the ability to

reallocate funding to meet provincial goals

• Hospitals who are not performing may

have activity and funding withdrawn

• Done in collaboration with RVP
• Year-end reconciliation considers actual

performance against target and may result in a recovery of dollars

• Impacts on future allocations

Essential Elements to Drive Accountability

• Clear structure, process and

requirements

• Role clarity (CCO, RVP, hospitals)
• Agreements
• Regional focus
• High quality data
• Incentives