Ontario Health Teams: What We Know Today Confidential for - - PowerPoint PPT Presentation

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Ontario Health Teams: What We Know Today

Ontario’s Case for Change

The Premier’s Council on Improving Healthcare and Ending Hallway Medicine has highlighted key areas in which Ontario’s healthcare system is under pressure, and exhibiting clear symptoms of strain:

Source: Hallway healthcare: A System Under Strain, First Interim Report of the Premier’s Council on Improving Healthcare and Ending Hallway Medicine, January 2019

The Patient Experience

Patients are receiving care in unconventional spaces such as hallways and waiting too long to receive their care in a system that is increasingly difficult to access; as a result, our hospitals are crowded.

Different healthcare Needs

There are more patients with complex needs and an increase in chronic issues that require careful and coordinated management, like an aging population living longer with high rates of dementia. Fair access to healthcare across the province continues to be a concern.

Responsibility and Accountability in the System Stress on Caregivers and Providers

Healthcare providers, family members, and friends are feeling the strain of a system that isn’t making caregiving

• easy. This leads to high levels
• f stress and places a heavy

burden on caregivers to act as advocates for timely and high- quality healthcare services.

Immediate and Long-Term Capacity Pressures

Ontario does not have an adequate or appropriate mix of services and beds throughout its healthcare system. Ontario’s healthcare system is large. Responsibility for coordinating high-quality healthcare is spread across many organizations. There is a fundamental lack of clarity about which service provider should be providing what services to patients and how to work together effectively. Ontario could be getting better value for the money it currently spends on the healthcare system.

Legislative Background

The People’s Health Care Act, 2019

The Act lays out two strategic initiatives aimed at addressing these challenges: the establishment of Ontario Health and the development of Ontario Health Teams

• 1. Consolidating and streamlining a number of

health care oversight agencies

• In Ontario Health these consolidated functions will

serve to operationalize Ministry of Health and Ministry of Long-Term Care policy

• 2. The promotion of Ontario Health Teams as

provider-led vehicles for improved delivery- system integration

1 2

Key Components/Benefits: Ontario Health Teams

Overall, the People’s Health Care Act is aimed at improving holistic health outcomes for Ontario’s population, by addressing challenges in the structure of the system and its incentives. Key components of the OHTs include:

Costs of Care

 Integrated systems will deliver care closer to home – not in expensive Emergency Departments.  Ontario Health Teams will be clinically and fiscally - accountable for the health

• f their population.

Access to Care

 A key success factor for the transformation will be ending “hallway medicine” in Ontario.  Teams will include hospitals, family doctors, social services, and sometimes unexpected partners.  Partners will work together to innovate and design a more patient-centred system.  Enhanced digital services will make managing health and wellness more convenient. Defined target population Integrated patient care and experience Shared governance and accountability Unified performance measurements Coordinated continuum of care Meaningful patient and community engagement Shared funding envelope A ‘ digital first’ approach Key benefits to the system are expected to include:

What Integrated Care will look like in Ontario

• Healthcare will be delivered by 50 – 80 Ontario Health Teams

(OHTs), made up of:

• Primary Care
• Hospitals
• Home and Community Care
• Palliative Care
• Long-Term Care
• Mental Health and Addictions Support
• Additional social services
• Each OHT will be accountable for ~300,000 patients within its

geography, with its funding tied to care for its patient population

• Each OHT will have a single Accountability Agreement with

Ontario Health, the province’s health care agency

Ministries of Health and Long-term Care

OHT OHT OHT OHT OHT OHT OHT OHT OHT OHT OHT OHT OHT OHT OHT

Ontario Health

OHT

The OHT Application Process

All providers have been invited to begin the continuous readiness assessment process:

At each stage of readiness, prospective teams will receive supports from MOH to move forward to full implementation. Support will also be provided to those who do not get selected during the first round.

Source: MOHLTC, April 2019

1 Partners assess their own readiness

across 8 OHT components.

Self-assessment

Patient Care & Experience Patient Partnership & Community Engagement Defined Patient Population In-Scope Services Leadership, Accountability, Governance Performance Measurement, Quality Improvement, Funding and Incentive Structure Digital Health

2 A selection of groups will be invited to

submit a full application.

Full application

3 Based on ministry review, a selection

• f sites will undergo an in person visit.

In-person visit

 Full Applications will be reviewed and evaluated and those that demonstrate a higher degree of readiness for implementation will be invited to participate in an In-Person Visit.  During this visit, providers will be expected to present a comprehensive current state assessment of their system and a vision for the future of patient care in the near and longer-terms. Further details will be provided to groups selected for an in-person visit.

Deadline May 15. 2019 Deadline October 9, 2019

Initial OHTs announced in late 2019

Results of the Self-assessment

• Of the 157 Self-assessments submitted on May 15, 2019…
• 71 were graded in discovery (45%)
• 46 were graded in development (29%)
• 31 were approved to advance to the next phase, and submit a Full Application on October 9, 2019 (20%)
• 9 were graded as Innovative Models (6%)

Source: MOHLTC, July 2019

71 46 31 9

Number of Applicants In discovery In development Approved Innovative model

Chatham-Kent OHT is one of the 31 groups approved to move to the next phase of the OHT application

Where we are Today – the Full Application

About your population About your team How will you transform care? How will your team work together? How will your team learn and improve? Implementation planning and risk analysis Membership approval Home and Community Care Digital Health

*Source: MOHLTC OHT Full Application, July 2019

Key Info on Full Application

• 10x the size of self-assessment
• Made up of 7 Sections plus 2 Appendices, generally

aligned to the self-assessment

• Each emerging OHT is provided with an attributed

patient population

• Reviewed jointly by the Ministry and a third party

The Full Application, Section by Section

1 2 3 4 5 6 7 A B

Provincial Ambition: Achieving the Quadruple Aim

The quadruple aim serves as a ‘True North’ principle for the current transformation

Adapted from MOHTLC, OHT Guidance Figure 2

Better Patient and Caregiver Experience Better Patient, Population Health Outcomes Better Value and Efficiency Better Provider Experience

People know how to navigate the system to meet their care needs People can get access to the care they need, when and where they need it Health-related quality of life is improved Effective and appropriate care is provided to patients Use of system resources is optimized Providers have high levels of confidence in the system and provider health is supported

Quadruple Aim Desired Outcomes

Nine Traits of Successfully Integrated Care

What does Effective Partnership look like in emerging OHTs?

Inclusive Partnerships

All sectors of care are invited to participate in the OHT strategic planning sessions. This includes social services and non-traditional partners.

Trust Amongst Partners

Trust, mutual respect, and clear lines

• f accountability allow the partners to

come to decisions as a system and moves forward against a tight timeline.

No Organizational Egos

When designing the future system of care, partners are able to put aside the short-term interests of their

• rganization, and recognize the value

that others bring to the table.

Patient-Centred Planning

Patients (i.e. patients/clients, families, and caregivers) are deeply involved in system design, and have a voice at the leadership level of the OHT.

Transparency in Communication

Decision making is transparent, and communication is frequent, especially at the leadership level of the OHT.

True Collaboration Amongst Partners

All the partners have a voice in the co-design of the system. Cross- sectoral teams work together to define what the future of healthcare looks like.

Confidential for discussion – NOT FOR CIRCULATION

The Journey So Far

Population Health and Well-Being in Chatham-Kent

Compared with the rest of Ontario, Chatham-Kent shows the following trends:

• Consumes fewer fruits and vegetables
• Higher rates of smokers than average
• Lower activity levels and higher amount
• f overweight people
• Higher use of ED and admissions to

hospital

• Among highest use of prescription
• pioids in Ontario

Young and growing Indigenous population

• Higher rates of unemployment and

lower than average income levels

• More people accessing social

assistance Over 20% of adults with less than a high school education

• Higher rates of Chronic Disease,

specifically: arthritis, diabetes, asthma, hypertension, mood disorders, and COPD

Past Collaboration in Chatham-Kent

April 27 – Partner Workshop to Prepare for Self- assessment

“Achieving the best health and well-being together” – draft vision statement created through the LHIN’s Sub-region Accountability Table.

• Achieving: Outcome and action oriented from the outset.
• Best Health & Well-being: Holistic in its ambition and responds to the unique perspective and goals of the individual.
• Together: Celebrates the concepts of collective impact. Highlights the role of patients/clients and all partner organizations in responding to the

voice and direction of patients/families.

Attendees

• Nurse Practitioners and

Clinicians

• Alzheimer's Society
• CK Children’s Services
• CK Community Health

Centre

• CKHA
• CK Hospice
• Children’s Treatment

Centre

• CMHA Lambton-Kent
• Erie St. Clair LHIN
• Foundation of CKHA
• Henry Ford Health System
• March of Dimes Canada
• Municipality of CK
• New Beginnings
• Ontario Hospital

Association

• Osler
• Riverview Gardens
• Sensory Technologies
• St. Andrew’s Residence
• St. Clair College
• Thamesview FHT
• Tilbury District FHT
• TransForm
• Vancouver Coastal Health
• Westover Treatment Centre

Outcomes

Lead indicator: Reduce hospital days per 1,000 patient population.

Overall focus on: a decrease in bed days, ED visits, wait times, ALC, and sick days AND an increase in patient and staff satisfaction, staff retention, use of community services, access of primary care, funds available for reinvestment, and consistent use of standardized protocols across continuum.

May 15 – Submission of the CKOHT Self- assessment

The CKOHT Signatories of the Self-assessment Geography Served:

• Municipality of

Chatham-Kent

• Walpole Island
• Surrounding rural

areas Older adults that are also complex / frail or living with chronic disease(s) conditions. Priority Population for Year One

• Chatham-Kent Community Health

Centres

• March of Dimes Canada
• Chatham-Kent Family Health Team •
• St. Andrew's Retirement Residence
• Chatham-Kent Health Alliance
• Thamesview Family Health Team
• Chatham-Kent Hospice
• Tilbury District Family Health Team
• Erie St. Clair LHIN Home &

Community Care

• Westover Treatment Centre

1) Build on success of Chatham-Kent Health Links 2) Improve transitions with 24/7 care coordination and system navigation 3) Expand access to care with virtual community ward and extend primary care hours 4) Improve self-management and health literacy 5) Expand ability to self-manage access to health care and information Areas of Focus for CKOHT

June 25 –Community, Physician and Partner Engagement Session

Design Principles

These draft design principles, created during the June 25th workshop, will be used to help inform difficult decision making:

• 1. Develop around the client to create a patient-centred model that wraps around health and social services.
• 2. Build for the uniqueness of the Chatham-Kent catchment area.
• 3. Be bold and innovative in design. Trust one another to take risks.
• 4. Leverage existing assets intelligently. Build for maturity, not Year 1.
• 5. Use an evidence-driven approach and be willing to continuously improve.
• 6. Integrate the full system and spectrum of care, including the community and social supports.

Patient and Family Engagement Strategy Topics Discussed

• 1. System Navigation
• 2. Care Pathways
• 3. Transportation
• 4. Access to Care
• 5. Data Sharing, Communication,

and Privacy

• 6. System Equity
• 7. Health Literacy Funding
• 8. Workforce
• 9. Implementation & Change

Management In the session’s final exercise, attendees designed the outline of an OHT-wide patient and family engagement strategy composed of the following components: For each topic below, attendees discussed current challenges, potential solutions, and existing assets to leverage:

• 1. Strategic Goals
• 2. Engagement Principles
• 3. Stakeholders
• 4. Forms of Engagement
• 5. Forms of Communication
• 6. Immediate Next Steps

CKOHT Steering Committee

Steering Committee Co-Chaired by: Lori Marshall, CEO, Chatham-Kent Health Alliance; Judy Gragtmans, Patient Advisor; Dr. Jim Wheeler, Physician, Thamesview Family Health Team Steering Committee Membership:

CKOHT Steering Committee and Work Streams

CKOHT Steering Committee

Population, Performance, Quality Home and Community Care Diversity and Equity Integrated Care Design Digital and Virtual Access Governance and Leadership

Population, Performance and Quality

• Recommend Y1P size and composition
• Identify members of the proposed CKOHT membership:
• Primary Care Physicians or Physician Groups, Partner Organizations, Patient Advisors, etc.
• Collaborating Organizations (e.g. Tertiary care centres and provincial entities), secondary (co-
• p) and post-secondary (PSW program) school systems
• Identify top performance improvement opportunities (measures)
• Create a Strategic Management Framework for planning with Quality Improvement, Change

Management, Communications and Engagement

• Co-design and engage with patient advisors using HQO’s patient engagement framework

Home and Community Care

• Long-term vision for the design and delivery of Home and Community Care (includes HSP and ESC

LHIN H&CC delivery) incorporating the patient and caregiver voice

• Short-term action plan for improving Home and Community care in Year 1 including single patient

navigator, coordinated care planning, self-management and self-directed care, patients without a PCP and connecting homeless patients with a patient navigator, etc.

• Proposed processes on how to transition Home and Community Care responsibilities
• Identification of barriers to Home and Community Care Modernization (includes legislative,

regulatory and policy barriers)

Integrated Care Design

• Deliver seamless and effective transitions
• Offer 24/7 access to coordination of care
• Provide system navigation to help people easily understand their options and pathways

to receive services they need

• Improve patient self-management and health literacy
• Increase support for caregivers

Diversity and Equity

• Specific Equity Considerations – considering the sub-groups of the attributed populations
• Working with Diverse Populations (Indigenous, Francophone, etc.) – applying the principles of

“Active Offer” and adding diversity lens to team-based care:

• Anti-oppressive, inclusive approaches
• Engagement with Patients – as co-leads of steering committee and members of work streams:
• Development of the collaborative governance structure (in design)
• Experience-based design events/sessions/focus groups in planning
• Community Input - CKOHT will identify opportunities, gaps and barriers through multi-faceted

community engagement methods to improve the patient experience:

• Perspectives of community members (urban, rural, etc.)
• Client experience feedback informally and formally through multi-faceted approaches

Governance and Leadership

• Will recommend a preferred option for transitional system governance/leadership of the CKOHT
• Recommendations will enable focus on service integration and collaboration
• Transitional governance/leadership will build on and solidify local collaboration that has enabled

partners to work together voluntarily, leveraging collaboration agreements

• Primary care and clinician participation in system governance/leadership will be critical in achieving

success

Digital and Virtual Access

• Current state assessment has been completed:
• Assessed how information can be shared amongst members in a secure manner
• Assessed risk associated with obtaining Year 1 goals
• Assessed how to leverage existing digital capabilities to provide virtual services
• Assessed availability of digital tools to provide patients and caregivers access to

patient information electronically

• Leveraging the MOH Digital Health Playbook to ensure alignment with provincial digital

health strategies

Confidential for discussion – NOT FOR CIRCULATION

Thank You