Health System Funding Reform: Driving Change using Technology Presentation to Canadian Health Informatics Association

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1 Health System Funding Reform: Driving Change using Technology Presentation to Canadian Health Informatics Association April 2014 Ministry of Health and Long-Term Care V2.4 ( )

2 Session Objectives To provide a high-level overview of Health System Funding Reform Highlight the role and importance of technology, communication and information in support of funding reform and the healthcare system as a whole 2

3 Our Vision to Achieving Value Our goal is to make Ontario the healthiest place in North America to grow up and grow old Our Goals 1. Keeping Ontarians Healthy 2. Faster access and a stronger link to family health care 3. Right care, right time, right place 3

Our Strategy to Achieving Value Health system transformation is about redesigning the system to allow for more flexible delivery models which promote access, quality and allows for services to be

4 Pillars of Transformation Wellness & Prevention Funding Reform Right Care, Right Place, Right Time Integration & Execution Empowering people to make healthier choices and improving health outcomes

4 Our Strategy to Achieving Value Health system transformation is about redesigning the system to allow for more flexible delivery models which promote access, quality and allows for services to be provided in a fiscally sustainable manner. Transformation will be guided by evidence and co-designed with the sector. 4 Pillars of Transformation Wellness & Prevention Funding Reform Right Care, Right Place, Right Time Integration & Execution Empowering people to make healthier choices and improving health outcomes for children Paying for health care services based on the needs of the patient and on performance to drive quality, efficiency and effectiveness Maximizing investments by shifting services to more appropriate and cost effective settings and optimizing existing resources Strengthening coordinated care to improve access to health care services and maximizing quality and value A focus on standardization, appropriateness, productivity and safety, innovation implemented at scale is essential. 4

5 Health Links: Current State The response to Health Links in year one has exceeded expectation There is at least one Health Link in every LHIN and some LHINs have full coverage. Future: 90+ Health Links, providing full coverage across the province we re already halfway there! The impact of other early successes have centred around local and regional innovations in programming, clinical pathways, and governance. Population Coverage: 7,723, Health Links Total Number of High Users: 720,000 Over 1000 multi-sectoral Partners 5

6 Health System Funding Reform Aligning Incentives and Accountabilities by Funding For High Quality Care and Better Patient Outcomes 6

We are moving from the global provider-focused funding model to one that revolves around the person Global Funding Health System Funding Reform A historical approach where

Base annualized funding o o New incremental funding Remaining funding acquired from other sources (i.e. preferred accommodation, alternative revenue etc.

7 We are moving from the global provider-focused funding model to one that revolves around the person Global Funding Health System Funding Reform A historical approach where health service providers received lump sum funding Hospitals, on average, received 75-90% of their funding from global budgets Majority of the funding is in the form of: o Base annualized funding o o New incremental funding Remaining funding acquired from other sources (i.e. preferred accommodation, alternative revenue etc. ) An evidence-based approach with incentives to deliver high quality care based on: Best available evidence and best practices Needs of the population served Services delivered Number of patients 7

Ontario s Health System Funding Reform (HSFR) approach will draw from over 25 years of international Activity Based Funding experience Patient focused funding systems reimburse providers

8 Ontario s Health System Funding Reform (HSFR) approach will draw from over 25 years of international Activity Based Funding experience Patient focused funding systems reimburse providers at an established rate, based upon quality care for standard patient groups Ontario is one of the last leading jurisdictions to move down this path Patient Focused Funding Adoption Timeline 8

Ambulatory Nursing Health Disciplines Pharmacy Clinical

9 Activity Based Funding is about Patients Patient care needs the information and accessibility that technology brings Ambulatory Nursing Health Disciplines Pharmacy Clinical Laboratories Medical Imaging Peri Operative Services Infrastructure 9

10 Health System Funding Reform (HSFR) has two funding components Health-Based Allocation Model (HBAM) HSFR Quality-Based Procedures (QBPs) Global Funding (Non-HSFR) HBAM is a made in Ontario' funding model QBPs are clusters of patients with clinically related diagnoses/ treatments and functional needs identified by an evidence-based framework Note: At the culmination of HSFR, HSPs will account for approximately 70% of funding 10

demographics Age, gender, growth projections, socio-economic

11 1. Health Based Allocation Model (HBAM) A funding model that optimizes the allocation of available funding Patient demographics Age, gender, growth projections, socio-economic status and geography Clinical data Complexity of care and type of care Financial data 11

12 2. The Quality in Quality-Based Procedures Best practices informed by clinical consensus and best available evidence Engage in clinical process improvement/re-design and adopt best practices Best practice pricing to strengthen the linkage between quality and funding Develop indicators to evaluate and monitor actual practice Broaden scope of QBPs to strengthen the continuity of care Ensure every patient gets the right care, at the right time, at the right place 12

13 Developing and Implementing QBPs Acute Inpatient Entering Year 3 ( ) of QBP implementation To date ( and ), QBPs represent 11% of the total provincial budget Transition from Acute Inpatient Admissions Existing QBPs expanded to address transition from inpatient admission/episode Community Concurrent work underway to define community-focused QBPs Integrated Indicator Scorecard Provide a starting point for monitoring and evaluating the impact of the introduction of each QBP 13

14 Technology and Healthcare Advances Technology can play a role in containing costs, improving access, and saving lives An electronic medical record system is often touted as the utopian marriage of healthcare and technology savvy, so let s $$$$ Encourage hospitals and doctors offices to digitize health care records $$$$ Get better at crunching data to offer a better diagnosis and treatment $$$$ Help doctors communicate with patients and their peers We re spending more, but are we getting value for our money? 14

15 Data (System) Requirements for Healthcare Funding Financial Data MIS, HBAM, QBPs, Forecasting and Budgeting Clinical Data EMR, HBAM, QBPs, CPOE, Order Sets Case Costing Data QBPs, Human Resources, Materials and Supplies, Medical Technology Utilization Management Data Capacity Planning Performance Measurement Data Indicators/Scorecards/Dashboards Workload Measurement Data Impact Analysis Business Intelligence 15

16 The Trouble with Data Data not understood is bad data No matter how much data we have, we always want more No matter how good and validated the data is, we always want it to be better No matter how quick it is, it could always be available quicker Everyone else has better information systems than we do The darn data never answers the questions it should The data doesn t always prove what we know is right 16

17 Data Quality Culture Components of a Good Culture Understanding 17

Management Information Systems (MIS) HBAM Modelling Population Statistics Canada census data and Ministry of Finance population projection

18 Multiple Data Inputs into HSFR Modelling Clinical Acute Inpatient (DAD) Day Surgery (NACRS) Emergency Room (NACRS) Inpatient Rehab (NRS) Complex Continuing Care (CCRS) Inpatient Mental Health (OMHRS) Home Care (HCD) Financial Ontario Cost Distribution Methodology (OCDM) Management Information Systems (MIS) HBAM Modelling Population Statistics Canada census data and Ministry of Finance population projection updates Socio-economic Status From Statistics Canada Rurality Medical Trainee Days HBAM Adjustments Case Costing Ontario Case Costing Initiative QBP Calculation 18

19 Coding and Data Quality: Raising the Bar It s not the Ministry s data: it s the organization s Overt and transparent link between coded patient data and funding Improved data quality benefits everyone Documentation (physician and departmental) challenges need to be resolved, need for issues to be escalated Likely need new data elements; keeping abreast of standards even more important Patient Assignment to all QBPs based on coded data Funds to be paid for different QBPs will vary Not all patients fit a QBP criteria Capacity planning it s not just about volume reconciliation 19

20 Clinical (Patient) Coding and Data Quality Complete, clear, and accurate documentation is the foundation for complete and accurate coding of all types of medical records Normal scapegoat for any performance results is coding What role does Computer Assisted Coding have? Education sessions held by Medical Records departments for physicians and clinicians usually result in improved quality of charted data Main concern is getting physicians to consistently and accurately ensure highest quality of charted data Data review process Optimizing processes 20

21 Deficiencies in Documentation Deficiencies in the documentation result from: Failure of health care provider to record information Lack of detail or specificity Conflicting or inconsistent information Illegible documents Missing documents 21

22 Computerized Physician Order Entry (CPOE) Process of entering medication orders or other physician instructions electronically instead of on paper charts The use of a CPOE system can help reduce errors related to poor handwriting or transcription of medication orders Although CPOE systems are designed to mimic the workflow of the paper chart, their adoption has been slow, largely because of: Disruption to existing care settings Cost of implementation which includes training 22

23 CPOE Benefits Helps organizations facilitate widespread CPOE physician adoption with streamlined order entry pathways, interactive worklists, and evidence-based order sets CPOE Reduces: Misinterpretations and transcription errors by eliminating handwritten medication orders Callbacks to physicians for clarification of ambiguous, incomplete, or illegible orders Medication order turnaround time: from ordering to dispensing to administration 23

24 What are Order Sets? Conveniently grouped medical orders that work to standardize diagnosis and treatment following pre-established clinical guidelines Step-by-step, evidence-based checklists that are used by clinicians to order treatments for patients Interacts with many hospital processes and support structures such as: Drug formulary Medication policy manual Approved abbreviations Method of undertaking diagnostic procedures Allow a physician to stop the practice of treating patients completely from memory 24

25 Summarizing Provides (and operationalizes) innovation Technology Is not the panacea for all of our healthcare woes But it is essential to help us move forward If technology helps facilitate cost-effective care, it is providing value 25

26 Raising Awareness Keeping you informed of HSFR-related communication and education opportunities Public website: Targeted to general public and includes presentations, videos, and frequently asked questions Private website: (password required) Targeted to health service providers and includes HSFR memorandums, education materials, and archived webinars New users can create an account by clicking on Create new account from the main homepage. 26

27 Contact our helpline for questions! or direct your enquires related to HSFR to the ministry health system funding Helpline: or call

28 Questions and Comments 28

29 Appendix

30 QBP Multi-Year Roll-out Plan Year Year 1 ( ) Year 2 ( ) Year 3 ( ) 1. Primary hip replacement* 2. Primary knee replacement* 5. Chronic obstructive pulmonary disease* 6. Stroke* 7. Congestive heart failure* Wave Hip fracture* 12. Pneumonia 13. Tonsillectomy 14. Neonatal jaundice QBPs 3. Cataract 4. Chronic kidney disease 8. Non-cardiac vascular 9. Chemotherapy 10. Gastrointestinal endoscopy Wave Coronary artery disease 16. Aortic valve replacement 17. Cancer Surgery 18. Colposcopy 19. Knee Arthroscopy 20. Retinal Disease 21. Short-Stay Post-hospital Discharge Homecare: Medical Discharge 22. Short-Stay Post-hospital Discharge Homecare: Surgical Discharge *These QBPs have or are being further developed and expanded to address transition to post-acute phase in Year 3 ( ). 30

Health System Funding Reform: Aligning Levers and Incentives to Achieve Excellent Care for All

Health Quality Branch Health System Funding Reform: Aligning Levers and Incentives to Achieve Excellent Care for All Ontario Long-Term Care Association Quality Forum June 12, 2013 Miin Alikhan Director,