LHIN Engagement of IHFs in Planning, Coordinating and Delivering Diagnostic Services

1. LHIN Engagement of IHFs in Planning, Coordinating and Delivering Diagnostic Services Presented by: Deborah Hammons, CEO Central East LHIN Paul Huras, CEO South East LHIN September 20, 2013

2. Session Objectives • An Introduction to Ontario’s Local Health Integration Networks; • Health Links • LHINs and IHFs – Working Together

3. Local Health System Integration Act, 2006 (LHSIA) “The purpose of this Act is to provide for an integrated health system to improve the health of Ontarians through better access to high quality health services, coordinated health care in local health systems and across the province and effective and efficient management of the health system at the local level by local health integration networks.” 2006, c. 4, s. 1.

4. Ontario’s LHINs manage approximately $22 Billion in Health Care Expenditures • Provincial: • OHIP & Doctors • Family Health Teams • Other Practitioners • Provincial Drug Programs • Trillium GoL / organ donations • Ontario Drug Benefit • Public Health • Private Labs • Ambulance Services • Independent Health Facilities • Provincial Networks / Programs • LHIN • Public and Private Hospitals • Long-Term Care Homes • CCAC • Community Mental Health and Addictions • Community Health Centres • Community Support and Service Agencies • e.g. Meals on Wheels 4

5. The LHIN Mandate and Functions

6. Planning Focus on creating an integrated, high performing health system that is accessible and sustainable

7. Funding & Allocation Flow dollars to health service providers in an appropriate and timely manner

8. Accountability and Performance Monitoring Getting the most of the public’s investment in their health care system and being accountable for results.

9. Community Engagement LHINs and Health Care Providers are required to engage the community in establishing health care plans

10. Goals of Community Engagement • Renew and maintain focus on the people who use health care • Enhance local responsiveness and accountability • Balance priorities • Develop system capacity and sustainability • Build confidence in our Public Health Care

11. How we Engage • Local Advisory Teams or Collaboratives • Board to Board • Priority Portfolio Steering Committees, Networks and Task Groups • Community input into Integrated Health Service Plan • Symposiums • LHIN Website • Presence at local events • Open Board meetings

12. What the LHIN means by Integration • Integration is: • to co-ordinate services and interactions between different persons and entities • to partner with another person or entity in providing services or in operating • to transfer, merge or amalgamate services, operations, persons or entities • to start or cease providing services • to cease to operate or to dissolve or wind up the operations of a person or entity

13. Integration: In simple language… • Health system experienced as a coordinated system: People will get the right treatment at the right time by the right provider • Seamless flow of information that supports patient care • A system that begins with primary care providers with an equal focus on prevention and health maintenance • Create timely access to quality services by aligning people, processes and resources • Elimination of wasteful and time consuming duplication • Involvement of patients, residents, family and informal caregivers

14. Expectations for our Health Service Providers • Implement the directions for integration laid out in the accountability agreements with LHINs • Inform their Boards and engage their community of these expectations • Aligntheir strategic and service planning within the overall LHIN framework, with specific reference to the priorities identified in the 2013-2016 Integrated Health Service Plan • Participate in LHIN planning exercises and provide the input and necessary information for the development of LHIN plans • Identify integration opportunities and demonstrate continuous improvement in service integration, coordination and quality

15. LHIN Accomplishments Since 2005, LHINs have served Ontarians by bringing health care planning and decision making to the local level – each LHIN is just now hitting its stride As mandated, LHINs have • Developed local health systems plans • Provided leadership in improving access to services by the development of regional systems of care • Responsibly managed the annual funding of $22B (over 20% of the Province’s budget) for local health services providers • Held Health Service Providers (HSPs) accountable for the funding LHINs provide, and for improved performance • Measured and reported on performance • Engaged the citizens of their local communities

16. LHIN Accomplishments (cont’d) • Recognized by health care experts as the only model of regionalization in Canada to bend the cost curve • After years of negative margins, LHINs have achieved a balanced hospital system • For the first time Ontario’s health care is being measured; these measurements are being reported to the public and used to set performance targets; and these targets are being achieved • Patients are waiting as much as seven months less for hips and knees (as well as cataracts, heart procedures, cancer surgery, etc.) – that’s seven month of less pain • An additional 1,000,000 Ontarians are reporting access to a family physician, and much of this is due to LHIN innovations, such as Health Care Connect, as well as other LHIN initiatives.

17. And Still More As has occurred in no other province, LHINs have created a new accountability and ensured alignment of Provincial, Regional and HSP priorities • Service Accountability Agreements (SAAs) mean that for the first time HSPs are aligned with provincial and regional priorities • SAAs ensure that LHINs are allocating and HSPs are expending resources to achieve consistent improvement across the province • SAAs ensure performance targets are set for each HSP, performance measured, and outcomes improved

18. Community Health Links 18

19. Minister’s Action Plan • Keeps people healthy • Focused on prevention, promotion, and self-management • Developed strategies for priority populations • Faster access to family health care • Have built a strong primary care foundation, with broad access to specialty and community services • Right care, right time, right place • Focused on patient-centric delivery • Implemented standardized system-wide approach to quality management and improvement • Have governance models that engage clinicians and the public in decision-making, enabling informed service provision that meets community needs in a timely way • Developed a system structure to integrate services along the continuum of care, optimize coordination, and foster effective partnerships • Utilized shared electronic medical records 19

20. Pan-LHIN Health System Imperatives • Enhancing Access to Primary Care– focused on advancing strategies to ensure people have timely access to a primary care provider and creating enabling structures and processes to align primary care more effectively within the overall continuum • Enhancing Coordination & Transitions of Care for Targeted Populations– e.g. Seniors Strategy: focus on seniors have individualized plans of care that allow them to receive the care they need, when and where they need it; and the transitions post-acute are smooth and coordinated • Implementing Evidence Based Practice to Drive Safety- focused on high priority safety issues that require consistent, coordinated responses to ensure that patents are safe and that adverse events are minimized/eliminated • Holding the Gains– focused on ensuring that new initiatives will not cause previous gains to be eroded (e.g., ER/ALC, ER Wait Times, and access to care, coordination amongst providers, enhanced focus on accountability) 20

21. What Stakeholders Have Told Us Ontario’s Action Plan is ambitious. • Delivering on this agenda including the right care at the right time in the right place requires that patients and providers work together more closely than they have in the past. • The partnership required goes far beyond a relationship between a LHIN and a hospital or a hospitals and a CCAC; it needs to include the person at the centre, primary care providers, and community partners. • Primary care providers are essential to transformation, whether its taking more responsibility for keeping people well, screening them appropriately for chronic diseases or managing their care when they are sick. • But it’s not only providers that are essential – patients need to be part of transformation as they experience the system and know better than anyone where and how the system can improve. • Stakeholders have asked for the flexibility to deliver services differently, in a way that best meets the needs of communities, to move resources between providers and to be held to account for better outcomes for patients. • There is consensus around the need for local (sub-LHIN) partnerships that would come together to deliver better value for money, ensure higher-quality of care, and improve access. They can also allow for deeper engagement with patients and help develop a true patient-centred focus to the system

22. An Early Focus – High Users • The Ministry is proposing to focus on high users in the first phase of transformation. According to ICES: • 5% of the users (685,000 people) account for approximately $15.2 B in health care costs, approximately 40% (2007$) • If we could achieve a 10% reduction in the costs of the 5% highest users we would save $1.5 B (2007$) and approximately $2 B in 2012$. • Despite the high cost, in several cases the patient experience and quality of care is not improving. • Over 271,000 emergency room visits were made to Ontario hospitals that could be treated in alternative settings (2010/11). • Over 140,000 instances of patients being re-admitted to hospital in Ontario within 30 days of their original discharge (2009/10).

23. Strengthening Execution & Integration • Introduce a new model of care at the clinical level where all providers in a community, including primary care, hospital, community care, are charged with coordinating plans at the patient level. • Health Links will be designed around, and accountable for system-level metrics established by the province. • Their initial focus will be on the high users, as we know that this segment of the population use a disproportionate amount of care at a cost which is not sustainable, nor appropriate for their needs. • Health Links will be accountable to the LHINs and will initially be voluntary, beginning with those partnerships that meet specified requirements. Over time, the entire province would be represented. • Leadership, governance, composition and integration initiatives will be flexible based on local need. Robust primary care participation is a critical success factor. • LHINs will work with providers that form the Health Link to ensure they put collaborative initiatives in place that will allow for a measurable, positive impact on patient care: • Improvements in care delivery (e.g. appropriate system utilization, care coordination) • Improvements in patient experience • Reduced costs Health Links – Partnering for Patients

25. Health Link Model: Core Features

26. Short-Term Mandatory Requirements The following features must be in place to be eligible for Health Link implementation in the short-term (November/December announcement): • Must be focused on, or prepared to focus on, a defined region with a minimum population of 50,000, organized around natural health service utilization patterns. • Must include health care providers/organizations involved in the care of the high use/high need population cohort, which at a minimum includes hospital, Specialists, CCAC and primary care. • Member providers must already show a high degree of collaboration and must be willing to sign written agreements formalizing their participation in the Health Link. • Member providers need to have the ability to identify and track the high use/high needs population cohort (some assistance can be provided). • Collaborating providers include minimum of 65% (TBC) of primary care providers in the region. • An identified and accepted Lead Organization in good standing as it relates to accountability and governance.

27. Health Link Implementation – Medium Term • Following the announcement of the early adopters, the ministry would ask the LHINs to identify the next partnerships ready to proceed, based on specific criteria.

28. Health Link Implementation – Roles

29. Health Link Performance Metrics • A focused set of indicators which are consistent across providers, are measurable, and represent meaningful change in the sector will be needed. • With the immediate focus on high-users, the following would be expected as the short-term indicators, with others being added over time. Short Term Indicators Average cost per high user patient Patient Satisfaction % seniors/high users with primary care provider Continued focus on Wait Times (ED to be revised) Time from referral to first home care visit Appropriate ED use Hospital ALC 30 day readmissions to hospital Same day/next day access Time from referral to specialist consultation Aspiration Metrics 5 Million More Days at Home 5 Million More Years of Healthy Life

30. Appendix B: Health Links Governance Structure MOHLTC Leadership Health Links Advisory Table Ministry, LHIN & Sector Representatives Accountability LHINs Transparency Facilitation/SWAT Team LHIN Representatives MOHLTC Representatives Excellent, High Quality, Patient-Centred Care Health Link …n Link Lead: TBD Health Link 3 Link Lead: TBD Health Link 2 Link Lead: TBD Health Link 1 Link Lead: TBD

31. LHINs and IHFs Working Together

32. How Can LHINs and IHFs Work Together IHF’s involvement in IHSP process: • Next IHSP 2014/5 • IHF reps need to meet with LHIN CEOs • Get on LHIN CEOs’ radar • Participate in community or focused engagement • Submit brief to LHIN

33. How Can LHINs and IHFs Work Together How can LHINs facilitate the coordination of diagnostic services between hospitals & IHFs?: • Need for a directory of IHFs per LHIN, including scope of services and volumes • LHINs could host meetings of IHF representatives and hospital representatives • LHIN could invite IHFs to regional hospital CEO meetings

34. How Can LHINs and IHFs Work Together Opportunities for the involvement of IHF’s in LHIN activities and committees: • IHF health professionals could apply to be members of LHINs’ HPAC • IHF association could develop relationship with CEO Council • Individual IHFs could develop relationship with LHIN CEO • LHIN CEOs could ensure IHFs are represented on their diagnostic planning groups, etc.

35. How Can LHINs and IHFs Work Together Rules of engagement for IHF’s to work with LHINs: • LHINs are looking to improve access to high quality care within the current fiscal realities • IHFs should not be looking for more funds • IHFs need to approach LHINs about how they can contribute to a more integrated system and to more effective delivery of services.

36. How Can LHINs and IHFs Work Together Should funding of IHF’s be under the auspices of LHINs?: • The issue is not so much the funding, it is more the accountability to the LHINs • Accountability and Service Accountability Agreements (SAAs) are more about alignment of priorities and not about the heavy hand • I think IHFs would gain more from accountability then they would risk • Re: funding, being accountable to LHINs, means LHINs could flow funds to IHFs, such as from annual community sector increases (i.e. 4% increase 2014)

37. How Can LHINs and IHFs Work Together How might Community-Based Specialty Clinics impact IHF’s?: • Who knows? • IHFs might be a good model for the clinics • We would expect specialty clinics to be accountable to LHINs, but who knows • We may need to wait another month or so

38. How Can LHINs and IHFs Work Together • LHINs are committed to improving access to high quality care • We value the role IHFs play in regional systems of integrated care • We are very interested in uniformly strengthening our relationships with IHFs • We offer to invite your representatives to meet with the LHIN CEOs at near future meeting

39. The LHINs Are Relationship Builders LHINs are building relationships with and among our local communities, including: • Patients • Governing bodies, • HSP executives • HSP frontline staff • Doctors

40. The LHINs Are The Listeners LHINs are listening to: • Local communities • HSPs and their health professionals • MOHLTC • And using this input to complement quantitative information to make informed decisions

41. Concluding Messages • Because of LHINs, health service providers in the province are working towards commons goals that will improve outcomes for patients and families. • LHINs are well aware of the health care challenges facing rural communities. • We are working diligently to simultaneously improve patient experience and health system outcomes using local intelligence and levers for performance improvement. • LHINs are continuing to evolve the health care system while evolving themselves.

42. Thank You Questions? For more information visit Ontario LHINs athttp://www.lhins.on.ca