The Future of Health Care in Ontario

Dr. Suzanne FilionVP, Development and Integration

HGH, Prescott-Russell

November 28th, 2019

Addiction & Mental Health Network of Champlain

The Council

3

• 3-year term; 14 members.

• Experience across all sectors.

• To identify strategic priorities and actions that will lead to

✓ improved health and wellness outcomes for Ontarians✓ high patient satisfaction✓ more efficient use of government investment✓ using an effective delivery structure

Council’s Mandate

4

Dr. Rueben Devlin

Christine Elliott Doug Ford

Presentation Name5

Conseil du PM /

PM’s Council

Patient-e/Patient

Coût/Cost

Pourvoyeur / Provider

Population

Sub-Committees

• long-term care • mental health and addictions • home and community care • digital health and innovation• hospital care• primary care

Council Reports

7

January 2019

Hallway Health Care: A System Under Strain

June 2019

A Healthy Ontario: Building A Sustainable

Health Care System

Report 1:

Challenges Within Ontario’s Health Care System

8

System Capacity and Hallway Healthcare

Long-Term Care

Home and Community Care

Emergency

Department Acute

In-

Patient

Rehab

Long-Term Care

Home and Community Care

Primary Care

PT FLOW: Impact on hospital occupancy and hallway healthcare.

Patient Inflow Patient Outflow

Primary Care

Mental Health & Addictions

Mental Health & Addictions

Day

surgery,

clinics

A

L

C

HomeHome

10

11

RESEARCH COMMUNITY

Confidential dialogue with leading

Canadian health and economic policy

researchers

5

REGIONAL SESSIONS

Ten local engagement

sessions and 16 virtual

francophone sessions

with over 1000

patients, providers and

sector leaders

4PUBLIC

Over 500

responses

received via email

and Minister’s

Patient Advisory

Council

2

SECTOR-BASED ADVICE

Six Sub-committees

comprised of

~80 sector leaders

1

Engagement and Consultationafter Report 1

STAKEHOLDERS

Ongoing meetings in response

to requests from stakeholder

and advocacy groups

3

The Council received feedback about the first report, and advice to inform its second report from:

An Integrated Healthcare Leader: Kaiser Permanente

Kaiser Permanente is leading in population health and quality of care through a full integration along

the care spectrum

Nationally recognized system: 17 KP facilities have received the highest level of Patient-Centered Medical Home Certification from the National Center for Quality Assurance3

Better integration leads to better care: high-risk patients are flagged by KP HealthConnect, in one case reducing 90-day emergency department readmissions by 30%, in addition to significant mortality reductions4

100% patient chart access rate: KP HealthConnect guarantees that health providers have access to patient charts from all patient interactions (e.g., via phone, emergency room visit, scheduled visit), in order to provide the most appropriate care5

Kaiser Permanente (KP) is America’s largest non-profit integrated healthcare consortium, operating in 8 states and serving 11.7 million health plan members. The consortium consists of Kaiser Foundation Hospitals (KFH); the Kaiser Foundation Health Plan (KFHP), an insurance company; and Permanente Medical Groups (PMGs), self-governed physicians groups. KP has been broadly cited by health professionals and academic journals alike as the leading model of a patient-centered integrated healthcare system.1

Leading Practices Success & Impacts

• Integrated administrative infrastructure and processes, such as risk-sharing agreements, can encourage quality care and align incentives

• Truly integrated healthcare systems are enabled by a robust and interoperable IT framework that connects medical practitioners and empowers patients

• Performance metrics and financial incentives should promote cross-network collaboration, enhance quality of care, and better patient health outcomes

Fully integrated delivery model: KFHP (insurance arm) and PMGs (physician groups) engage in mutually exclusive contracts to provide care and ensure quality

• Both parties enter a “risk sharing arrangement”

• The model eliminates volume-related incentives (i.e., no financial gain from driving up high-intensity services)

EHR as an enabler of integration: KP HealthConnect, the EHR system, improves care coordination by making all patient information available to all care providers

• System allows for automatic real-time updates and messaging between providers

• Patient portal provides secure patient-provider messaging, access to health records

• Contract non-KP providers treating KP patients can access EHR, ensuring seamless care; non-member hospitals can get patient information telephonically 24/7

Quality of care incentivized over volume: KP physicians are paid a salary independent of services performed, and are eligible for a 6-9% bonus for care quality2

Source: 1Kaiser Permanente Press Release, 2017; 2Brookings Center for Health Policy, 2015; 3Health Care Reform Insights, 2013; 4Brookings Center for Health Policy, 2015; 5Healthcare Information and Management Systems Society, 2018

Considerations for Ontario

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Report 2: Roadmap for the Future… BUILDING A SUSTAINABLE SYSTEM

• The report identifies 10 action items under four themes that will put enablers in place – and remove barriers – to help the health care system modernize.

• At the same time, the government is moving forward with plans to create Ontario Health and form Ontario Health Teams.

13Council

14

Integration Innovation

Efficiency/Alignment

Capacity

SECOND REPORT4 THEMES, 10 RECOMMENDATIONS

System

Transformation

16

GOALS

Government and Bureaucrats

Ontario Health (OH) and Centre of

Excellence

LHINs and new regions

OHT

17

System Transformation GoalsThe government’s objective is to build a modern, integrated and sustainable public health care system.

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Modernizing:• Public Health• Emergency

Health Services

• Supply Chain

Integrating Service Building Capacity Connecting Care

• Mental Health & Addictions

• Long-Term Care• Hospitals• Home & Community

Care• Scopes of Practice

OHT Digital Options

MODERNIZATION

19

Ontario Health Teams

Local health planning and implementation

Ontario Health

A single accountable agency. System management.

Ministry

Strategic development, oversight, and funder

REGIONAL OFFICES

20

Ministers

DeputyMinisters

HEALTH LTC MENTAL HEALTH

Associate MinisterMichael Tibollo

Christine Elliott

Marie-LisonFougère

Marrilee Fullerton

Helen Angus

Ontario Health / Santé Ontario

21

Board ChairBill Hatanaka

CEOSusan Fitzpatrick

Former

Toronto Central LHIN CEO

ADM Health System Delivery and Implementation, MOHLTC

Former

President and CEO, OPSEU Pension Trust

Group Head, Wealth Management, TD Bank Group

Centre of ExcellenceMOH Newsroom, May 27, 2019

“Creating the centre follows recommendations made in 2010 by the Select Committee on Mental Health and Addictions, co-chaired by Elliott and established through a motion she presented. Within Ontario Health, the proposed Mental Health and Addictions Centre of Excellence would:

• Establish a central point of accountability and oversight for mental health and addictions care.

• Be responsible for standardizing and monitoring the quality and delivery of services and clinical care across the province, to provide a better and more consistent patient experience.

• Provide support and resources to Ontario Health Teams, which is a new model to integrate care and funding, connect patients to the different types of care they need and help them navigate the system. “

Lee Fairclough

Former VP, HQO

CEO, St-Mary’s General Hospital, Kitchener ON

23

•Cancer Care Ontario

•Health Quality Ontario

•eHealth Ontario

•Health Shared Services Ontario

•HealthForceOntario Marketing

and Recruitment Agency

•14 Local Health Integration

Networks

•Trillium Gift of Life Network …

soon

Ontario Health /

Santé Ontario

24

•Cancer Care Ontario

•Health Quality Ontario

•eHealth Ontario

•Health Shared Services Ontario

•HealthForceOntario Marketing

and Recruitment Agency

•14 Local Health Integration

Networks

•Trillium Gift of Life Network …

soon

Ontario Health /

Santé Ontario

Transfer Notices Issued

Nov. 13th.

Into effectDec. 2nd

AGENCY DUTIES AND RESPONSIBILITIES

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System management and performance

•planning and delivering health care

•improving the quality of care

•measuring and managing how the system performs

•enabling innovation

•ensuring financial accountability

•providing clinical leadership

Ontario Health / Santé Ontario

26

Population-based programs and clinical

and quality standards

•overseeing highly specialized care (for

example, cancer, organ donation)

•managing provincial population health

programs (for example, cancer screening)

•overseeing critical care

•investigating and supporting new and

emerging health services

•developing evidence-based advice for

delivering health services and clinical care

Ontario Health / Santé Ontario

27

Back office support and system oversight

•managing supply-chains

•assessing and planning for local needs

•holding accountability for Ontario Health Team

Ontario Health / Santé Ontario

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EasternOntario

ITR

Toronto

INTERIM TRANSITIONAL REGIONS (ITR)announced Nov. 13th, 2019

30

INTERIM TRANSITIONAL REGIONS (ITR)announced Nov. 13th, 2019

South East

Champlain

Central East

OntarioEast

31

INTERIM TRANSITIONAL REGIONS (ITR)announced Nov. 13th, 2019

East

Toronto

Central

West

North

REGIONS

32

Region Clustering of LHIN Corporations

1- WestErie-St. Clair, South West, Hamilton Niagara Haldimand Brant, Waterloo

Wellington: Bruce Lauckner

2- CentralMississauga Halton, Central West, Central, North Simcoe Muskoka:

Scott McLeod

3- TorontoToronto Central:

Tess Romain

4- EASTCentral East, South East, Champlain:

Renato Discenza

5- NorthNorth West, North East:

Rhonda Crocker Ellacott

HEALTH TEAM

ACUTE

LTCH

HCC

PC 24/7

MHA

PALLIATIVE

ONTARIO HEALTH TEAM ÉQUIPE SANTÉ ONTARIO

Enablers• Digital Health• Virtual Care• Care Coordination

A “must”• Pt/Cl, families and

caregivers, peers

OHTSubmittedProposal

Results

34

Moving to full application (31)

In Development (41)

In Discovery (approx. 70)

Innovative (9)

CURRENT CHAMPLAIN OHTsin development

35

✓ Prescott-Russell

✓ Winchester

✓ Cornwall

✓ Arnprior

✓ Pembroke

✓ Deep River

✓ Renfrew

✓ Kemptville

Progress Report … Jan. 20, 2020

Full Application … March 2020

FULL PROPOSALSSUBMITTED

✓ Ottawa Centre✓ Ottawa East✓ CHEO & Partners

Full Application … Oct. 2019On-site visits … Mid Nov. 2019

Annoncement … End Nov. 2019

36

NEXT DATES

- “In Discovery”- New batch Self-Assessment

…Dec. 4th, 2019

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November 25, 2019

First Cohort of Ontario Health Teams

This morning, the first of 24 Ontario Health Teams (OHTs) was announced by Christine Elliott, Deputy Premier and Minister of Health. Congratulations to the Mississauga OHT (Mississauga Health).

In the coming weeks, the government will be announcing each OHT in communities across Ontario. Here is what you can expect:

•Minister Elliott and/or government officials will be visiting each of the OHTs in their communities to officially announce each one and celebrate with the teams.

•You can follow along with the announcements by visiting theOHT web page. The list of teams will be updated as each is identified.

•Once all 24 teams have been introduced, a complete list of all OHTs will be announced and details about next steps will be shared with all teams that have submitted an application.

Ministry of Health <connectedcare@ontario.ca>

38 Premier’s Council on Improving Healthcare and Ending Hallway Medicine

Measuring Success and Moving Forward

Measuring Success

39

Improved

Patient and

Caregiver Experience

Improved

Health of Ontarians

Reduced Costs

Improved

Work-Life

of

Providers

The recommendations in the Premier’s Council’s second report

are well-aligned with the objectives of the Quadruple Aim.

1 2 3 4

40

1

Use policy tools to overcome barriers,

such as:

• Outdated privacy legislation and multiple digital

platforms

• Wasted data collection with a high reporting burden

on providers

• Siloed services and agreements

• Reactive, not prevention-based care

• Mis-matched financial incentives and outdated

procurement approaches

Moving Forward

41

Digital solutions, collaboration, and

leadership are required for sustainable

change to the system.

• More virtual care options

• Data used as a management tool and using predictive

analytics and artificial intelligence to drive service delivery

• Co-ordinated treatment plans designed and delivered by

integrated and interprofessional teams

• Additional upstream interventions, broad range of

community services and supports

• Modernized funding models that promote value and quality

Barriers Enablers

42

“Digital First for Health”

Foundational efforts to support “Digital First for Health”

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Patient Digital Identity

Digital Health Information Exchange Policy (DHIEX)

PHIPA Modernization

Virtual Care

Cybersecurity

Playbook

Éliminer le FAX !!!

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November 15, 2019

Ontario is implementing a new Digital First for Health strategy that will help end hallway health

care by offering more choices and making health care simpler, easier and more convenient for patients, families and providers.

This strategy will harness the imagination and capabilities of Ontario’s digital health innovators to improve care for all Ontarians.

Once the new strategy is fully implemented, patients and caregivers will see a number of benefits, including:

•More virtual care options: Expanding availability of video visits and enabling other virtual care tools such as secure messaging.

Additionally, providers will be able to leverage a variety of virtual care technologies that best meet the needs of their patients.

•Expanded access to online appointment booking: Patients will be able to book appointments that best meets their needs.

•Greater data access for patients: More patients will be able to review their secure health record online and make informed choices about

their care.

•Better, more connected tools for frontline providers: More providers will be able to access patient records stored across multiple health service providers to provide better, faster care.

•Data integration and predictive analytics: Providers will face fewer barriers to integrating and using secure health information to manage health resources and improve patient care. This could lead to improvements such as earlier intervention and better management of chronic disease.

This is an exciting time for health care in Ontario as the government brings the patient experience into the 21st century.

The first phase of the digital strategy will include a $3 million in new funding to increase the availability of virtual care with approximately 55,000

more video visits provided by physicians directly to patients in their location of choice over the next year. In addition, this first phase will enable

Ontario Health Teams to collect, use and share information to allow for better patient care and outcomes. This will improve convenience for patients

and promote more connected care by ensuring patients won’t need to retell their health information over and over.

This will be achieved through the proposed changes Ontario is making to modernize the Personal Health Information Protection Act (PHIPA) that

will also introduce stricter provisions for any individual or organization that misuses personal health information.

The proposed changes will:

•Ensure Ontario Health and Ontario Health Teams can collect, use and share information to allow for better patient care and outcomes while clearly outlining how access to information is protected and remains private.

•Promote system integration by allowing for the ability to set common interoperability standards governing the use, disclosure and retention of digital health records, including requirements supporting the protection of patient privacy.

•Better protect personal health information by taking measures to ensure that patient privacy is respected and maintained.

PHIPA will also be strengthened by adding an offence provision and order making powers to deter individuals or organizations from compromising

patient privacy.

Ministry of Health <connectedcare@ontario.ca>

Public HealthandEmergency Health Services Consultations

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November 18, 2019

Public health and emergency health services

consultations

Earlier today, Christine Elliott, Deputy Premier and Minister of Health, launched the next phase of renewed consultations on

public health and emergency health services with stakeholders through a webinar and the release of two discussion papers.

These consultations will provide critical insights into the needs of the public health and emergency health services sectors,

municipalities and service providers. They will also provide an opportunity for direct input into the best way to deliver these

programs and services to meet the evolving needs and priorities of Ontario’s families.

Jim Pine, recently appointed advisor to the Ministry of Health, will lead this next phase of consultations as he works with

municipalities, the public health and emergency health services sectors, and other stakeholders to ensure that modernization is

informed by their advice and the daily realities of their communities.

The discussion papers are posted on the ministry web page for feedback:

• Public Health Modernization

• Emergency Health Services Modernization

We hope to receive your input.

If you have any questions or comments about the consultations, you can send an email to: ehsphmodernization@ontario.ca.

Ministry of Health <connectedcare@ontario.ca>

How will we contribute to enhancing our system?

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Questions?

Dr. Suzanne Filionsfilion@hgh.ca613-676-0386

Vice-President, Development and IntegrationHGH – Hawkesbury and District General Hospital

Member, PM’s Council on Improving Healthcare and EndingHallway Medicine

2nd Report

Council Recommandations

Report 2: Roadmap for the Future

INTEGRATION:

Recommendations 1-3

• How health care should be organized around patients and across providers to ensure it works in all of our communities.

52Council

53

1. Put patients at the centre of their health care. Patients should be well-supported and treated with dignity and respect throughout all interactions with the health care system.

2. Improve patients’ and providers’ ability to navigate the health care system, simplify the process of accessing and providing care in the community, and improve digital access to personal health information.

3. Support patients and providers at every step of a health care journey by ensuring effective primary care is the foundation of an integrated health care system.

Integration

INNOVATION:

Recommendations 4-5

• Growing demand and opportunity to use virtual care and create the right conditions for modern programs.

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4. Improve options for health care delivery, including increasing the availability and use of a variety of virtual care options.

5. Modernize the home care sector and provide better alternatives in the community for patients who require a flexible mix of health care and other supports.

Innovation

EFFICIENCY & ALIGNMENT:

Recommendations 6-8

• Overcoming traditional barriers to achieve a sustainable system.

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6. Data should be strategically designed, open and transparent, and actively used throughout the health care system to drive greater accountability and to improve health outcomes.

7. Ensure Ontarians receive coordinated support by strengthening partnerships between health and social services, which are known to impact determinants of health.

8. As the health care system transforms, design financial incentives to promote improved health outcomes for communities and increased value for taxpayers.

Efficiency & Alignment

CAPACITY:

Recommendations 9-10

• Maximizing existing capacity and planning for the future with the right mix of services.

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9. Address short- and long-term capacity pressures including wait times for specialist and community care by maximizing existing assets and skills and making strategic new investments. Build the appropriate health care system for the future.

10. Champion collaborative and interprofessional leadership development focused on system modernization capabilities.

Capacity