Ontario Medical Association Ontario Health Teams James Wright Moving forward with Integration in Ontario Sarah Hutchison Jennifer Gold Dara Laxer
Bill 74: The People’s Healthcare Act • Centralization of multiple agencies to be called Ontario Health • Introduces Integrated Care Delivery Systems (ICDSs), also known as Ontario Health Teams (OHTs)
Goals of Ontario Health Teams (OHTs) And what they are not • Goal: fully integrate across the continuum of care at a lower cost with plan to encompass province over few years • Quadruple aim (population health, patient experience, efficiency, provider experience) • Patient is at the centre with virtual care and access to information • OHTs are NOT a replacement for FHTs or other existing primary care models • OHTs are NOT a new payment model for physicians; PSA remains • OHTs will ultimately include component of risk/gain sharing: unclear what this means for MDs but this will not be included in first years, and is being discussed with OMA
OMA position • Voluntary • Physician lead • Primary care based
Expression of Interest (EOI) • Minimum of 3 care domains/services (Primary Care, Acute Care, and Community Care) in specific geographical area with goal to fully integrate care, including integrated information system (IIS) • 4-stage path to becoming an OHT: a) Self-Assessment or EOI Provider Readiness: Based on Self ‐ Assessments, Discovery or In Development stages of readiness b) c) OHT Candidate: Through an invitational, full application, group meets key readiness criteria d) OHT Designate: Integrated funding envelope with accountability agreement
EOI Domains • Patient Care and Experience • Patient Partnership and Community Engagement • Defined Patient Population • In Scope Services • Leadership, Accountability, and Governance • Performance Measurement, Quality Improvement, and Continuous Learning • Funding and Incentive Structure • Digital/Virtual Health • Details in Appendix A in Guidance Document, can be found at: http://health.gov.on.ca/en/pro/programs/connectedcare/oht/docs/guidance_doc_en.pdf
Fundamental for Success Two most important criteria • Strong effective working relationships • Integrated Information Systems
Are specialists included in OHTs? • Yes, the expectation is specialist care will be included in OHTs within hospitals and communities. • Government has recognized that there is some highly specialized care that may not be available within a constrained geographic situation • Specialist care in a region may need to be part of multiple OHTs
Should I consider participating? • We see no risk to learning and expressing willingness to participate; • The risk will come with final OHT contract with MOHLTC • Clarify new or shared accountabilities • Confirm funding model • Consider possible changes to practice autonomy • Clarify governance arrangements/responsibilities/role • Ensure appropriate contract and contract management • Review integrated information system and PHIPA expectations • Establish implications of risk and gain sharing
How will the OMA support members? • Support in identifying potential patient catchment populations and approximate budgets • Legal support to develop governance models and/or provide advice on contracts with clear accountabilities • Advice on appropriate governance models • Advice on patient/public engagement • Guidance in determining risk adjustment payments • Assistance in linking important potential partners • Regional manager support • Application review and feedback • Digital health service delivery advice through OntarioMD to facilitate integrated information systems and virtual care including privacy issues • Peer Leaders and Practice Advisors to support practice readiness (via OntarioMD)
OHT Governance: Principles to Consider • OMA endorses a model of governance with significant physician representation and participation • OMA envisions a “gold standard” governance model whereby participating entities elect or appoint individuals to sit on a board or governance organization that is enabled to make decisions for the OHT and ultimately act as fund holder • Contracts between and amongst groups will be necessary to execute functions, share data, and meet accountabilities required under any service agreement with the government • OMA is working on standardized governance model(s) and template contracts
OntarioMD Delivers a Suite of Digital Health Services OntarioMD Initiatives: Our Partners: Partnered Initiatives: 12
What does the Ontario Digital Health Landscape look like? -Confidential draft for discussion purposes only- 13
Digital Health Plan Digital Health Strategy Developing a Digital Health Plan The successful implementation of the OHT model will require groups to develop and implement effective digital health plans. As part of this process, OHTs are going to need to undertake the following: 1) Understand and articulate the current state of clinical workflows and processes for those organizations that will be part of the OHT, and their use of supporting digital health technology. 2) If necessary, redesign clinical workflows and undertake process redesign activities to support integrated care delivery. 3) Describe the end state of digital health for the OHT. 4) Outline the key activities to be undertaken over the next 12 months to begin to move from the current state to the end state. This Playbook provides guidance for all of the above. The Ministry of Health and Long- Term Care’s overarching goals are to enable OHTs to be innovative and flexible while also ensuring that a minimum set of data can flow provincially, and the Playbook outlines the different mechanisms that OHTs should use to achieve these goals. In some circumstances, this will entail the adoption of common core solutions, while in other cases OHTs will have local flexibility within an interoperable, standards-based framework. As part of the OHT support model, the ministry and its delivery partners will be available to assist OHTs in developing their up-front digital health plan to guide this work moving forward. -Confidential draft for discussion purposes only- 14
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Important Dates for OHT Applicants Assessment process Dates . Open call for self-assessments April 3, 2019 Deadline to submit self-assessments May 15, 2019 Selected groups will be invited to submit a Early July 2019 full application Deadline to submit full applications September 2019 Announce Ontario Health Team candidates Fall 2019 Deadline for Second Round of self- Fall 2019 assessments
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