Ontario Health Teams: What We Know Today Confidential for discussion – NOT FOR CIRCULATION
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: Different healthcare Needs Stress on Caregivers and Providers The Patient Experience There are more patients with Patients are receiving care Healthcare providers, family complex needs and an increase members, and friends are in unconventional spaces in chronic issues that require feeling the strain of a system such as hallways and careful and coordinated waiting too long to receive that isn’t making caregiving management, like an aging easy. This leads to high levels their care in a system that is population living longer with high increasingly difficult to of stress and places a heavy rates of dementia. Fair access to burden on caregivers to act as access; as a result, our healthcare across the province advocates for timely and high- hospitals are crowded. continues to be a concern. quality healthcare services. Immediate and Long-Term Capacity Responsibility and Accountability in the System Pressures Ontario’s healthcare system is large. Responsibility for Ontario does not have coordinating high-quality healthcare is spread across an adequate or many organizations. appropriate mix of services and beds There is a fundamental lack of clarity about which throughout its service provider should be providing what services to healthcare system. patients and how to work together effectively. Ontario could be getting better value for the money it currently spends on the healthcare system. Source: Hallway healthcare: A System Under Strain , First Interim Report of the Premier’s Council on Improving Healthcare and Ending Hallway Medicine, January 2019
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 1 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 2 provider-led vehicles for improved delivery- system integration
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: Defined target Integrated patient care Shared governance and Unified performance population and experience accountability measurements Coordinated Meaningful patient and Shared funding A ‘ digital first’ approach continuum of care community engagement envelope Key benefits to the system are expected to include: Costs of Care Access to Care A key success factor for the transformation will be Integrated systems will deliver care ending “hallway medicine” in Ontario. closer to home – not in expensive Teams will include hospitals, family doctors, social Emergency Departments. services, and sometimes unexpected partners . Ontario Health Teams will be clinically Partners will work together to innovate and design a and fiscally - accountable for the health more patient-centred system. of their population. Enhanced digital services will make managing health and wellness more convenient.
What Integrated Care will look like in Ontario Ministries of Health Healthcare will be delivered by 50 – 80 Ontario Health Teams and Long-term Care (OHTs) , made up of: Primary Care Ontario Health 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 OHT geography , with its funding tied to care for its patient population OHT OHT OHT Each OHT will have a single Accountability Agreement with OHT OHT OHT OHT OHT Ontario Health, the province’s health care agency OHT OHT OHT OHT OHT OHT OHT
The OHT Application Process All providers have been invited to begin the continuous readiness assessment process: Deadline May 15. 2019 Deadline October 9, 2019 1 Partners assess their own readiness 2 A selection of groups will be invited to 3 Based on ministry review, a selection Self-assessment Full application In-person visit across 8 OHT components. submit a full application. of sites will undergo an in person visit. Patient Care & Leadership, Accountability, During this visit, providers will be Experience Governance Full Applications will be reviewed and expected to present a comprehensive Patient Partnership & Performance Measurement, evaluated and those that demonstrate current state assessment of their system Community Engagement Quality Improvement, a higher degree of readiness for and a vision for the future of patient care implementation will be invited to in the near and longer-terms. Further Defined Patient Funding and Incentive participate in an In-Person Visit. Population Structure details will be provided to groups selected for an in-person visit. In-Scope Services Digital Health Initial OHTs announced in late 2019 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
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%) 71 Number of Applicants 46 31 Chatham-Kent OHT is one of the 31 groups approved to move to the next phase of the OHT 9 application In discovery In development Approved Innovative model Source: MOHLTC, July 2019
Where we are Today – the Full Application The Full Application, Section by Section 1 About your population 2 About your team 3 How will you transform care? Key Info on Full Application 4 How will your team work together? 5 How will your team learn and improve? • 10x the size of self-assessment 6 • Made up of 7 Sections plus 2 Appendices, generally Implementation planning and risk analysis aligned to the self-assessment 7 Membership approval • Each emerging OHT is provided with an attributed patient population A Home and Community Care • Reviewed jointly by the Ministry and a third party B Digital Health *Source: MOHLTC OHT Full Application, July 2019
Provincial Ambition: Achieving the Quadruple Aim The quadruple aim serves as a ‘True North’ principle for the current transformation Desired Outcomes People can get access to the care they need, when and where they need it Better Patient and Caregiver Experience People know how to navigate the system to meet their care needs Effective and appropriate care is provided to patients Better Patient, Population Health Outcomes Health-related quality of life is improved Quadruple Aim Better Value and Use of system resources is optimized Efficiency Better Provider Providers have high levels of confidence in the system and provider health is supported Experience Adapted from MOHTLC, OHT Guidance Figure 2
Nine Traits of Successfully Integrated Care
What does Effective Partnership look like in emerging OHTs? Inclusive Partnerships Trust Amongst Partners No Organizational Egos All sectors of care are invited to Trust, mutual respect, and clear lines When designing the future system of participate in the OHT strategic of accountability allow the partners to care, partners are able to put aside come to decisions as a system and planning sessions. This includes the short-term interests of their social services and non-traditional moves forward against a tight organization, and recognize the value timeline. that others bring to the table. partners. Transparency in True Collaboration Patient-Centred Planning Communication Amongst Partners Patients (i.e. patients/clients, Decision making is transparent, and All the partners have a voice in the families, and caregivers) are deeply communication is frequent, co-design of the system. Cross- involved in system design, and have especially at the leadership level of sectoral teams work together to a voice at the leadership level of the the OHT. define what the future of healthcare OHT. looks like.
The Journey So Far Confidential for discussion – NOT FOR CIRCULATION
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