Implementing Patients First in the North East LHIN Focus in Year 1 Presentation to Health Service Providers May 24, 2017 Disponible en français.
Objectives • Set the Context – Provincial, Regional, Local • Outline approach • What we have heard • The Next Year … Common Purpose • Outline Next Steps 2
The Patients First Journey Patients First: Bringing Care Patients First: First Mandate Roadmap to Strengthen Home (Donner Action Plan for Letter Home and Community Report) Health Care Care September 2014 May 2015 January 2015 February 2015 Auditor General Price-Baker Patients First: Auditor General Province-wide Report on CCACs Report Discussion Report on CCACs consultation (Phase 1) Paper (Phase 2) January – April December 2015 August 2015 December 2015 2016 May 2015 Patients First: Reporting Patients First Patients First Act, 2016 Back on the Proposal to Patients First Act, 2016 Mandate Letters Act, 2016 Reintroduction Strengthen Patient- Introduction (Bill 210) Released becomes (Bill 41) Centred Health Care in legislation Ontario June 2016 September 2016 October 2016 June 2016 December 2016 3
Why Patients First … The Case for Change • Despite significant progress over the past ten years, we still need to do more to ensure that the health care system is meeting the needs of Ontarians. 1 Some Ontarians are not always well-served by the health care system ( equity ). Many Ontarians have difficulty seeing their primary care provider when 2 they need to, especially during evenings or weekends ( access ). Some families find home and community care services inconsistent and 3 hard to navigate; family caregivers can experience high levels of stress ( access ). Public health services are disconnected from parts of the health care 4 system; population health not a consistent part of system planning ( population health ). Health services are fragmented in the way they are planned and 5 delivered; fragmentation can affect the patient experience and can result in poorer health outcomes ( quality ). 4
Provincial Context … Sub-Regions Equity and Population Health • Identify priorities for collaborative • Identify high risk populations and work initiatives to address gaps and improve with PHUs to implement targeted patient experience and outcomes interventions for culturally sensitive care Public Health Primary Care • Creation of more formal linkages between • Assess capacity of primary care and the LHIN and public health develop plan • Begin implementation of plan to enhance Musculoskeletal (MSK) services and mood disorder care Community, Patient and Home and Community Care Caregiver Engagement • Implement strategies to improve access • Strengthen community engagement • Strengthen integration of primary care • Ensure engagement with FN and Indigenous and home and community care leaders, providers and patients • Improve transitions in care • FLS provision capacity assessment • One or more PFACs 5
Provincial Context … Performance Monitoring and Mental Health and Addictions Reporting • Provincial opioid strategy and local support to connect patients to treatment • Continue to report on progress toward services achieving health system performance • Map and expand access to structured targets psychotherapy and supportive housing Provincial Priorities Digital Health • Implementation of quality standards in • Work with local partners to leverage and partnership with HQO support uptake of digital solutions to improve access and referrals to specialists • Virtual models of care, digital self-care Innovation and Best Practices Capacity Planning and ALC • Implement identified regional high yield • Work with system partners to deploy strategies (including stroke care, Common local strategies to improve system flow, Intake Assessment Tool for lower hospital admission rate and Musculoskeletal Care) reduce ALC 6
Patients First – Five Key Components 1. Expanded Role for LHINs • LHINs are responsible for all health service planning and performance. • Sub-regions as focal point for integrated service planning and delivery. Timely Access to, and Better Integration of, Primary Care 2. • LHINs are responsible for primary care planning and performance improvement , in partnership with local clinical leaders. More Consistent and Accessible Home & Community Care 3. • Direct responsibility for service management transferred from CCACs to LHINs. Stronger Links to Population & Public Health 4. • Formalized linkages between LHINs and public health units . Improving Health Equity and Reducing Health Disparities 5. • Indigenous, Franco-Ontarians and other cultural groups. 7
Expanded Role for LHINs • LHINs are responsible for all health service planning and performance. • Sub-regions serve as a focal point for integrated service planning and delivery. 8
Sub-Regions: • Are smaller geographic units created to better address and understand patient needs at the local level. • Take into account the diverse geographic, population and demographic needs to deliver quality care in an effective and efficient manner, including to Francophone and Indigenous people . • Are based on existing care patterns, using the best available evidence , including engagement with patients, providers and community members. • Will support primary care practitioners, and other clinicians, as well as patients, caregivers and their families playing a role in planning, priority setting and implementing improvement activities . 9
Sub-Regions are: • NOT service boundaries – patients will continue to have their choice of where to receive services within and outside of the sub-region. • NOT an additional bureaucratic layer in health care service delivery. They are simply a better way for the NE LHIN to plan and improve health services in a manner that is more in line with the diverse needs of communities across this vast region. • About optimizing existing funding and making recommendations to the LHIN about priorities and future funding. 10
Sub-Regions in the North East 11
How does this all fit together? Criteria/ Primary Care Health Links Rural Health Hubs Sub-Region Planning Prerequisites Groups Focus Complex Patients, top 5% System System Local communities users of the health system All patients within the All patients within the geography of Where patients geography of Rural the Sub-Region, with initial focus on seek primary care Health Hub primary care and home and services community care alignment Population No size, although initially Less than 20,000 in Smallest: Individual recommended for rural or remote settings James and Hudson Bay Coast: communities or populations greater than (greater than 30 approximately 13,000 neighbourhoods 50,000; rural and urban minutes from next communities major community) Largest: Sudbury-Manitoulin-Parry Sound: 229,934 Patient Focus 4 or more chronic/complex All patients in Rural All patients in Sub-Region could All patients in a conditions, with emphasis Health Hub catchment benefit. Primary Care on palliative patients, frail area could benefit. Group seniors, mental health 100% of patients with access to patients, and inclusion of Primary goal is system primary care 100% of patients the social determinants of improvement have access to health Alignment of PC and HCC primary care Patient/Family Expected Expected Expected Expected in Engagement primary care organizations 12
Marie • Marie is an 85 year old grandmother. She lives in Northeastern Ontario just a few kilometers away from where she was born. • Marie lives by herself. She can’t find a primary care provider. • • Marie has painful hips and difficulty walking and seeing. • Recently, Marie fell down the stairs on her way to the laundry room. • She had to wait five hours before help arrived. We need a plan to transform this story … 13
Current System in the North East LHIN 565,000 Northerners navigating sectors of care H Home & Home & Specialists Community Community Diagnostics Primary Care 44 CMHA Care 41 LTCHs 6 CHCs 25 Hospitals Care Independent Practitioners Agencies (previously (70 CSS health facilities CCAC) Agencies) Limited shared accountability across providers or sectors. Accountable to MOHLTC Individual accountability agreements. Varying models Individual volume-based funding. Varied access to inter- *Note: Numbers based on unique HSPs professional, team-based care 14
Current Patient Experience Access Hospital/Acute Availability of core services Primary may vary across the Care Health Link NE LHIN and the Sub- Provider/ Walk-in Regions Navigation/Coordination Largely patient and family- Patients, Families, and directed Home Care Caregivers Communication Multiple care plans Long-Term Care Home CSS and MHA Service Agencies 15
Future State: Continuum of Care Emergency Care and Scheduled Procedures Local care team and Information care plan, Sharing rooted in primary and Patient, Families and community Primary Care, Caregivers care Care Coordination Health Links H&CC and MHA Long-Term Services Care Homes 16
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