WWLHIN Joint Planning Process Update and Next Steps February 20 and 22, 2008

1. Waterloo Wellington LOCAL HEALTH INTEGRATION NETWORK WWLHIN Joint Planning Process Update and Next Steps February 20 and 22, 2008

2. Presentation Overview 1. Challenge, Mission, and Values 2. WWLHIN System Planning Approach 3. Fall Joint Planning Meetings: Recommendations 4. 2008/09 Operating Plans • Sector submissions • Plans and H-SIPs • The link to the Aging at Home Strategy 5. Next Steps

3. Our Collective Challenge “A health care system that helps people stay healthy, delivers good care when they need it, and will be there for their children and grandchildren.” Ministry of Health and Long-Term Care Vision for Health Care 2005 1

4. WWLHIN Mission “Inspiring people to improve quality of life now and in the future through collaborative relationships and health system integration.” Live and Live Well in Waterloo Wellington 2

5. WWLHIN Values COMMUNITY Respect, engagement and focus on people INTEGRITY Sound decision making processes and honesty INNOVATION Creativity, future focus and change ACCOUNTABILITY Follow through, evidence-based outcomes and transparency 3

6. WWLHIN System Planning Approach

7. WWLHIN Governance New System Planning Approach All WWLHIN Health Service Providers’ (HSP) plans: • Reflect systems approach, collaboration, partnering • Take advantage of idea exchange at Fall 2007 Planning Meetings and other fora • Begin to create systems solutions: • To own pressures • To other HSPs’ challenges • Related to gaps and opportunities in WWLHIN identified priorities 4

8. WWLHIN Governance New System Planning Approach • HSP operating plans are aligned with WWLHIN priorities • Approve ‘System Plan’ • WWLHIN enters into new Service Accountability Agreements (SAA) with providers: • Hospitals enter into new SAAs by March 31, 2008, for 2008/10 • Others’ agreements to reflect system priorities for 2008/09 • CCAC, CHCs, MH&A, CSS enter into new SAAs by March 31, 2009, for 2009/11 • LTC Homes enter into new SAAs by March 31, 2010, for 2010/12 5

9. WWLHIN Joint Planning Meetings Recommendations

10. Joint Planning Meetings Discussion Topics: Mental Health Chronic Disease Management Continuity of Care Access to Primary Care Enablers: • HHR / staffing • E-health • Telemedicine Rural services New delivery models in LTC Consistent Themes: Access Effectiveness Sustainability Population Health 6

11. WWLHIN Governance Joint Planning Meetings • Access to Appropriate Care: Getting to our health system (1 of 2) • Maintain a single information source on services, both for other providers making referrals and for clients and families who need to know the options • Explore how agencies will support the CCAC Information and Referral mandate • Address the inefficiency that 20+ different community referral forms, processes, and wait list approaches create for ensuring access to service 7

12. WWLHIN Governance Joint Planning Meetings • Access to Appropriate Care: Getting to our health system (2 of 2) • Target special approaches to addressing gaps for vulnerable populations (e.g., homeless) • Access regional resources where ever possible (e.g., regional stroke, diabetes initiatives) • Target access to community services earlier in diagnosis to keep people in their homes longer (e.g., Alzheimer’s) • Grow rural and other satellite programs leveraging existing infrastructure (e.g., in CHCs) 8

13. WWLHIN Governance Joint Planning Meetings • Access to Appropriate Care: Navigating the system (1 of 2) • Support a ‘one number to call’system • For new initiatives, implement a plan to address system gaps first – both for program gaps, and for at-risk populations • Coordinate case management for frail elderly, at risk, and vulnerable populations • Put in place housing options 9

14. WWLHIN Governance Joint Planning Meetings • Access to Appropriate Care: Navigating the system (2 of 2) • Support specialized units in long term care (e.g., ABI, dementia) • Ensure a transportation web exists that supports the community service infrastructure • Co-locate services as appropriate (e.g., for rural outreach programs where existing infrastructure exists) 10

15. WWLHIN Governance Joint Planning Meetings • Sustainability: Building capacity to ensure a lasting health system (1 of 4) • Assess current user fees in the community sector • Address HHR and staffing • share positions • share staff training, education • Recruit as a LHIN • Explore shared pensions/benefits plans/HHR centralized administration 11

16. WWLHIN Governance Joint Planning Meetings • Sustainability: Building capacity to ensure a lasting health system (2 of 4) • Harness technology – e-health, telemedicine (OTN) • Address Infections control / pandemic planning • Identify and agree on benchmarks/thresholds/ definitions of wait list in all sectors • Review how community providers are funded 12

17. WWLHIN Governance Joint Planning Meetings • Sustainability: Building capacity to ensure a lasting health system (3 of 4) • Continue to partner to leverage strengths • Focus on innovative and non-traditional partners, such as Family Health Teams • Community agencies to seek back office efficiencies / economies of scale (e.g., bookkeeping/accounting) • Implement consistent referral forms, processes in the community sector 13

18. WWLHIN Governance Joint Planning Meetings • Sustainability: Building capacity to ensuring a lasting health system (4 of 4) • Coordinate Community services to reduce duplication • Eliminate duplicate reporting • Put in place Common / partnered wait lists / wait definitions • Community sector to share policies, procedures, decision tools wherever possible • CCAC and other community based services need to be coordinated 14

19. WWLHIN Governance Joint Planning Meetings • Effectiveness (1 of 3) Ensuring staff are trained to provide service needed: • Share staff training expertise, education resources (e.g., post training calendar) • Second staff to other WWLHIN sectors / agencies • Hospital professionals reach out to support community providers 15

20. WWLHIN Governance Joint Planning Meetings • Effectiveness (2 of 3) Models of Care: • Manage chronic disease (Iceberg) before becomes acute and required hospitalization • Share with other providers 'leading practices' • Crisis systems in place as needed • Team in LTC to deal with acute episodic events • Shared care model • Discharge planning role designed for client need and maximum system effectiveness 16

21. WWLHIN Governance Joint Planning Meetings • Effectiveness (3 of 3) Funding: • Allow flex in budgets to reward / encourage innovation • Assess funding formula for community services 17

22. WWLHIN Governance Joint Planning Meetings • Focus on Population Health (1 of 2) • Keep people healthy, out of the system, able to manage own care by ensuring access to primary care, health promotion and prevention • Promote physical activity, nutrition everywhere people live, at home, in retirement communities, in LTC Homes • Find preventive approaches to reduces repeat emergency visits (e.g., Air way clinic, diabetic education in the community) 18

23. WWLHIN Governance Joint Planning Meetings • Focus on Population Health (2 of 2) • Have mental health teams visit high schools to speak to teens about serious mental illness • Address services for seniors to keep them in their homes as long as possible • Address linkages to primary health care 19

24. 2008/09 Operating Plans

25. WWLHIN Governance Community Support Services • 26 WWLHIN-funded community support agencies • Several provide one program, others provide a range or ‘basket’ of services • Service plans submitted December 31, 2007 • Primarily balanced budget submissions • Common issues reemerging around wait listing clients and wait list management, consistency and criteria for program intake and assessment, confusing requirements for reporting • Many approaches to outreach and education • Common challenges with current reporting systems • Sector in infancy in terms of performance measurement 20

26. WWLHIN Governance Community Health Centres • 4 CHCs in WWLHIN • Plans submitted December 31, 2007 • Planning process for CHCs constrained by historic requirement of line-by-line funding of specific professional groups (e.g., physicians, nurse practitioners) • H-SIPs received for new services, service enhancements • 4 CHC joint H-SIP for collaborative e-health solution • Historic funding approach meant performance measurement important to individual CHCs while not a priority in sector 21

27. WWLHIN Governance Community Care Access Centre • Plan submitted January 31, 2008 • H-SIPs received for new services, service enhancements • Plan to balance budget includes protocol for wait list management for specified services • One time funding through urgent priorities to advance their information and referral mandate - will require ongoing provider collaboration 22

28. WWLHIN Governance Mental Health and Addictions • 20 WWLHIN-funded programs and services • Plans submitted January 31, 2008 • Primarily balanced budget submissions • H-SIPs submitted for service enhancement and new programs, and expansion • Aging at Home submissions more relevant to operating plans also considered in planning process • Managed as one sector for historic reasons results in a lack of clarity on the common issues emerging—with the exception of gaps in programs for specific populations • Strength of sector related to goal setting and measurement • Partnerships within mental health or addictions strong 23

29. WWLHIN Governance Hospitals • Draft plans submitted November 30, 2007 • Final plans submitted January 31, 2008 • Primarily deficit budget submissions over two years • H-SIPs for service enhancement, new program expansion • Aging at Home submissions more relevant to operating plans, also considered in planning process • Common issues emerging related to: Health Human resources; alternate level of care patients; access issues and wait lists for community services; lack of options in the community such as supportive housing; transitioning patients with concurrent disorders, complex mental health needs to the community 24

30. WWLHIN Assessment H-SIPs and Operating Plans In the following order, the WWLHIN considers proposed solutions that require: • More effective or efficient use of existing resources (2007/08) to two or more collaborating providers • More effective or efficient use of existing resources (2007/08) to a single provider • New resources (above the level of 2007/08 base allocation funding) shared between or among collaborating providers • New resources (above the level of 2007/08 base allocation funding) to be used by one provider 25

31. Link to Aging at Home Strategy • 1st Step: 88 original HSIPs • 2nd Step: 25 discrete business cases • Review and Selection • 3 distinct funding streams 1. Frail/Complex Elderly 2. Senior Health and Wellness 3. Supportive Housing • Innovation Funding (20%) • WWLHIN Approvals on February 28, 2008 26

32. Next Steps

33. WWLHIN H-SAA Negotiations • WWLHIN meeting with all the hospitals on February 25 to look at the sector in the systems context • Following that we will begin discussions with each hospital about their new Hospital Service Accountability Agreement (H-SAA) • March 28 WWLHIN Board will approve all 2008/09 plans, including hospitals 27

34. WWLHIN Governance Principles WWLHIN Negotiation Process Principles and Values • Trust and transparency • System transformation • Respect • Understanding respective roles • Collaborative • Responsive organizational structure • Development of a systems culture Accountability Integrity Innovation Community 28

35. WWLHIN Governance Timeline and Milestones Hospital Annual Planning Submission Guide released July 07 September WWLHIN All-Provider Joint Planning Meetings Hospital draft plans submitted – November 30 October November December Community Sector plans submitted – December 31 Mental Health and Addictions / Final Hospital plans Submitted – January 31 January 08 Review and approval plans Hospital negotiations February March 29

36. WWLHIN Governance Timeline and Milestones February Hospital Board Chairs & CEOs Briefing 4 Joint Planning Meeting follow up teleconference – all WWLHIN HSPs 19-22 H-SAA Negotiations Launch - Hospitals’ Senior Leadership Team 25 Meetings with individual hospitals, to discuss: ^ Leadership of integration opportunities ^ Hospital plans, risks opportunities and mitigation ^ Performance expectations 26-29 March 3-28 H-SAA Signed by all WWLHIN Hospital Boards 24-28 WWLHIN Board approve all operating plans; signs new H-SAAs with each hospital 31 30

37. Discussion