North East LHIN Focus in Year 1 Presentation to Health Service - - PowerPoint PPT Presentation

Implementing Patients First in the North East LHIN

Focus in Year 1

Presentation to Health Service Providers May 24, 2017 Disponible en français.

Objectives

• Set the Context – Provincial, Regional, Local
• Outline approach
• What we have heard
• The Next Year … Common Purpose
• Outline Next Steps

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Patients First: Action Plan for Health Care February 2015 Patients First: Reporting Back on the Proposal to Strengthen Patient- Centred Health Care in Ontario June 2016 Patients First: Roadmap to Strengthen Home and Community Care May 2015 Patients First: Discussion Paper December 2015

The Patients First Journey

Patients First Act, 2016 Reintroduction (Bill 41) October 2016 Patients First Act, 2016 Introduction (Bill 210) June 2016 Mandate Letters Released September 2016 Province-wide consultation January – April 2016 Bringing Care Home (Donner Report) January 2015 Auditor General Report on CCACs (Phase 2) December 2015 Auditor General Report on CCACs (Phase 1) August 2015 First Mandate Letter September 2014 Price-Baker Report May 2015 Patients First Act, 2016 becomes legislation December 2016

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Why Patients First … The Case for Change

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• Despite significant progress over the past ten years, we still need to

do more to ensure that the health care system is meeting the needs

• f Ontarians.

Health services are fragmented in the way they are planned and delivered; fragmentation can affect the patient experience and can result in poorer health outcomes (quality). Some Ontarians are not always well-served by the health care system (equity). Many Ontarians have difficulty seeing their primary care provider when they need to, especially during evenings or weekends (access). Some families find home and community care services inconsistent and hard to navigate; family caregivers can experience high levels of stress (access). Public health services are disconnected from parts of the health care system; population health not a consistent part of system planning (population health).

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Provincial Context …

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Sub-Regions

• Identify priorities for collaborative

initiatives to address gaps and improve patient experience and outcomes

Primary Care

• Assess capacity of primary care and

develop plan

• Begin implementation of plan to

enhance Musculoskeletal (MSK) services and mood disorder care

Home and Community Care

• Implement strategies to improve access
• Strengthen integration of primary care

and home and community care

• Improve transitions in care

Equity and Population Health

• Identify high risk populations and work

with PHUs to implement targeted interventions for culturally sensitive care

Public Health

• Creation of more formal linkages between

the LHIN and public health

Community, Patient and Caregiver Engagement

• Strengthen community engagement
• Ensure engagement with FN and Indigenous

leaders, providers and patients

• FLS provision capacity assessment
• One or more PFACs

Provincial Context …

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Performance Monitoring and Reporting

• Continue to report on progress toward

achieving health system performance targets

Digital Health

• Work with local partners to leverage and

support uptake of digital solutions to improve access and referrals to specialists

• Virtual models of care, digital self-care

Capacity Planning and ALC

• Work with system partners to deploy

local strategies to improve system flow, lower hospital admission rate and reduce ALC

Mental Health and Addictions

• Provincial opioid strategy and local

support to connect patients to treatment services

• Map and expand access to structured

psychotherapy and supportive housing

Provincial Priorities

• Implementation of quality standards in

partnership with HQO

Innovation and Best Practices

• Implement identified regional high yield

strategies (including stroke care, Common Intake Assessment Tool for Musculoskeletal Care)

Patients First – Five Key Components

1. Expanded Role for LHINs

• LHINs are responsible for all health service planning and

performance.

• Sub-regions as focal point for integrated service planning and

delivery. 2.

Timely Access to, and Better Integration of, Primary Care

• LHINs are responsible for primary care planning and performance

improvement, in partnership with local clinical leaders. 3.

More Consistent and Accessible Home & Community Care

• Direct responsibility for service management transferred from

CCACs to LHINs. 4.

Stronger Links to Population & Public Health

• Formalized linkages between LHINs and public health units.

5.

Improving Health Equity and Reducing Health Disparities

• Indigenous, Franco-Ontarians and other cultural groups.

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Expanded Role for LHINs

• LHINs are responsible for all

health service planning and performance.

• Sub-regions serve as a focal

point for integrated service planning and delivery.

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• Are smaller geographic units created to better address and

understand patient needs at the local level.

• Take into account the diverse geographic, population and

demographic needs to deliver quality care in an effective and efficient manner, including to Francophone and Indigenous people.

• Are based on existing care patterns, using the best available

evidence, including engagement with patients, providers and community members.

• Will support primary care practitioners, and other clinicians, as well as

patients, caregivers and their families playing a role in planning, priority setting and implementing improvement activities.

Sub-Regions:

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• NOT service boundaries – patients will continue to have their

choice of where to receive services within and outside of the sub-region.

• NOT an additional bureaucratic layer in health care service
• delivery. They are simply a better way for the NE LHIN to plan

and improve health services in a manner that is more in line with the diverse needs of communities across this vast region.

• About optimizing existing funding and making

recommendations to the LHIN about priorities and future funding.

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Sub-Regions are:

Sub-Regions in the North East

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How does this all fit together?

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Criteria/ Prerequisites Health Links Rural Health Hubs Sub-Region Planning Primary Care Groups Focus Complex Patients, top 5% users of the health system System All patients within the geography of Rural Health Hub System All patients within the geography of the Sub-Region, with initial focus on primary care and home and community care alignment Local communities Where patients seek primary care services Population No size, although initially recommended for populations greater than 50,000; rural and urban communities Less than 20,000 in rural or remote settings (greater than 30 minutes from next major community) Smallest: James and Hudson Bay Coast: approximately 13,000 Largest: Sudbury-Manitoulin-Parry Sound: 229,934 Individual communities or neighbourhoods Patient Focus 4 or more chronic/complex conditions, with emphasis

• n palliative patients, frail

seniors, mental health patients, and inclusion of the social determinants of health All patients in Rural Health Hub catchment area could benefit. Primary goal is system improvement All patients in Sub-Region could benefit. 100% of patients with access to primary care Alignment of PC and HCC All patients in a Primary Care Group 100% of patients have access to primary care Patient/Family Engagement Expected Expected Expected Expected in primary care

• rganizations

Marie

• Marie is an 85 year old grandmother. She lives in Northeastern

Ontario just a few kilometers away from where she was born.

• Marie lives by herself.
• She can’t find a primary care provider.
• Marie has painful hips and difficulty walking and seeing.
• Recently, Marie fell down the stairs on her way to the laundry

room.

• She had to wait five hours before help arrived.

We need a plan to transform this story …

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Current System in the North East LHIN

565,000 Northerners navigating sectors of care

Specialists Diagnostics Independent health facilities 6 CHCs Primary Care Practitioners Home & Community Care (previously CCAC) 25 Hospitals Home & Community Care (70 CSS Agencies) 44 CMHA Agencies 41 LTCHs

H

Accountable to MOHLTC Varying models Varied access to inter- professional, team-based care Limited shared accountability across providers or sectors. Individual accountability agreements. Individual volume-based funding.

*Note: Numbers based on unique HSPs

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Current Patient Experience

Access

Availability of core services may vary across the NE LHIN and the Sub- Regions

Navigation/Coordination

Largely patient and family- directed

Communication

Multiple care plans

Patients, Families, and Caregivers Health Link Hospital/Acute Primary Care Provider/ Walk-in Home Care CSS and MHA Service Agencies Long-Term Care Home

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Patient, Families and Caregivers Primary Care, Care Coordination Local care team and care plan, rooted in primary and community care

Information Sharing Emergency Care and Scheduled Procedures

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Long-Term Care Homes H&CC and MHA Services Health Links

Future State: Continuum of Care

NE LHIN Sub-Region Development Approach in Year One will be:

• mindful of what we have heard through our engagements over

the years – and the good work already underway both at the regional and sub-regional levels

• purposeful and deliberate
• about people and care processes: integrating the patient

voice into our decision-making

• mindful about creating new structures if not required to achieve

the desired outcomes

• transformative, meaningful and action oriented
• focused on problem solving
• simple and effective (we want to see and measure results).

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This is consistent with what we have heard over the years in the North East …

• Awareness of, and access to, services in the community is a

challenge.

• Opportunities exist for primary care services to be

strengthened and integrated in the community.

• People are assessed over and over – and need to tell their

story to each new provider.

• We need to focus on a few impactful priorities and avoid “trying

to boil the ocean.”

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Common Sub-Region Purpose for Year 1

QUESTION: When looking at Patients First and what Northerners (both residents and providers) have repeatedly told us through engagements and surveys … what is a natural shared priority for all North East sub-regions to address for the next 12 months to improve the patient experience and care outcomes? ANSWER: Delivering on … Home & Community Care and Primary

Care to better serve and support patients and their caregivers at the local level.

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How will this help you?

• You, your family, friends and neighbours will have greater access

to primary care and home & community care.

• Strategies will be implemented to prevent premature:
• Visits to emergency departments
• Admissions to hospital
• Admissions to long-term care homes.
• Primary care will be better supported by care coordination

services.

• People will have smoother transitions across the continuum of

care and have improved experiences.

• People will be better supported to live safely at home.

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Definitions for clarity …

Home & Community Care (Bringing Care Home, Gail Donner, Appendix D,

examples)

• “CCAC-Funded” (previously referred to): Care Coordination,

Nursing, Physiotherapy, Occupational Therapy, Speech- Language Pathology, Social Work, Personal Support, Medical Supplies & Equipment, Dietetics,

• “Community Support Services-Funded” (previously referred to):

Meals on Wheels, Transportation, Caregiver Respite, Adult Day Programs, Foot Care, Home Maintenance, Friendly Visiting, Security Checks, Assisted Living, Support for Visual Impairment,

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Definitions for clarity …

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Primary Care

1) Primary Care is the “level of a health service system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and co-ordinates or integrates care provided elsewhere by others.” (Barbara Starfield, 1998) 2) The first level of care in developed countries, including the services of family physicians, nurse practitioners, nurses, pharmacists, and

• thers. Core principles include:
• Universal access to care and coverage on the basis of need;
• Commitment to health equity as part of development oriented to

social justice;

• Community participation in defining/implementing health agendas;
• Intersectoral approaches to health.

(World Health Organization, 2003)

Definitions for clarity …

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A Patient’s Medical Home is a family practice defined by its patients as the place they feel most comfortable to present and discuss their personal and family health and medical concerns.

(College of Family Physicians of Canada, “A Vision for Canada: Family Practice – The Patient’s Medical Home”, 2011) Patient’s Medical Home Characteristics Patient-centered Comprehensive scope of family practice services Most Responsible Provider of care Continuity of care, relationships, and information Timely access to appointments Maintain EMRs Advocacy for and coordination

• f timely appointments with
• ther medical services

Commitment to continuous Quality Improvement

Timely Access to, and Better Integration

• f, Primary Care
• LHINs responsible for primary care planning and

performance improvement, in partnership with local clinical leaders. Primary Care Clinical Leads:

• NE LHIN/ Nipissing-Temiskaming: Dr. Paul Preston
• Sudbury-Manitoulin-Parry Sound: Dr. Jason Sutherland
• Cochrane: Dr. Yves Raymond
• Algoma: Dr. Dave Fera and Dr. Jodie Stewart

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Primary Care Strategy Overview

• Primary care is a patient’s medical home, and entryway to

both community services and specialty services. We need to strengthen primary care’s ability to play this role for all patients, including complex patients.

• We need to work with and listen to primary care providers

to determine how best to support communities and strengthen primary care to be the patient’s medical home.

• We will plan for 26 Primary Care Groups, which are

communities/neighborhoods where primary care providers work together to support 100% of patients.

• Clinical Leads will support our primary care physicians, NPs

and organizations to build plans to overcome local issues.

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Primary Care Priorities for 2017/18

Continue to build primary care as the foundation of the health care system to develop sub-region plans that:

• Use an equity lens to assess the number and proportion of primary

care providers based on the needs of the local population.

• Improve access to primary care providers including family doctors and

nurse practitioners.

• Facilitate effective and seamless transitions.
• Improve access to inter-professional health care providers.
• Implement a plan that embeds care coordinators and system

navigators in primary care to ensure smooth transitions.

• Support integration of Health Links into sub-regional planning.

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Home and Community Care Priorities

With input from patients, caregivers and partners:

• Reduce wait times and improve coordination and consistency
• f home and community care so that clients and caregivers

know what to expect.

• Continue to implement the initiatives in Patients First: A

Roadmap to Strengthen Home and Community Care. A key priority for 2017-18 is the completion and consolidation of the transition.

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Ten Steps to Strengthen Home & Community Care

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1. Develop a statement of home and community care values 2. Create a levels of care framework 3. Increase funding 4. Move forward with bundled care 5. Offer self directed care 6. Expand Caregiver supports 7. Enhanced support for PSWs 8. More nursing services 9. Provide greater choice for palliative and end of life care

• 10. Develop a capacity plan

For the Next Year … Our Common Focus

• Primary Care
• Home & Community Care Services
• Strengthening linkages between them
• This may involve aligning or leveraging existing structures.

(examples: existing collaboratives).

• As per the Patients First Act, each Sub-Region will develop a

Strategic Plan.

• This is a start and our initial focus for the next 12 months.

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Sub-Regions – Key Milestones

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FOUNDATIONAL ELEMENTS

People Needs Context Form / Function Measurement

Develop terms of reference and recruitment process for regional Patient and Family Advisory Committee Develop committee listing for each sub-region. April – May Winter 2016/17 June - August First Year: 2017/18 Sub-region processes implemented:

 Patient and Family

Advisory Council established

 Strengthening of Home &

Community Care and Primary Care linkages

 Implementation of Ten

Steps to Strengthen Home & Community Care

 Performance metrics and

common scorecards created for all HSPs – shared accountability

Complete In Progress Planned

NE LHIN boundaries for sub- regions approved by MOHLTC. Contribute to provincial methodology related to primary care capacity analysis Data to inform H&CC/PC priority shared with sub-regions. Primary Care Engagement Sessions Orientation sessions in May and June in four Sub- Regions (common purpose and approach) Sub-regions identify their preferred approach (the “how”). Discussion re simplifying existing committee structures  Primary Care  Home & Community Care  Strengthened linkages between them Inventory and analysis of existing committee structures

Next Steps

• Continue the good work that’s already underway!
• Work with LHIN staff in each Sub-Region.
• Refer to the inventory of existing tables (LHIN-funded HSPs)

and identify and implement opportunities to streamline.

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• Primary Care
• Home & Community Care Services
• Strengthen linkages between them

LHIN Officer Covers Sub-Regions

Robin Joanisse Algoma Jennifer McKenzie Algoma Christine Leclair Cochrane Mélanie Ciccone Cochrane Megan Waqué Nipissing/Temiskaming Nancy Lacasse Sudbury/Manitoulin/Parry Sound Carol Philbin- Jolette James & Hudson Bay Coasts

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• Primary Care
• Home & Community Care Services
• Strengthen linkages between them

Home & Community Care Director Covers Sub-Regions

Christianne Monico Algoma Cochrane James and Hudson Bay Coasts Kerby Audet Manitoulin-Sudbury-Parry Sound Nipissing-Temiskaming Cindy Croteau All Martha Musicco All Mary Tasz All Sherry Frizzell All

Staff of the NE LHIN

In conclusion…

• This is not new in the North East.
• Working together with a clear focus is critical.

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Questions?

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Thank You Merci Miigwetch

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