Ontario s Family Health Teams. Comprehensive Interprofessional Family Patient-Centred Health Care Team

Transcription

1 Ontario s Family Health Teams South East Toronto Comprehensive Interprofessional Family Patient-Centred Health Care Team Dr Thuy-Nga (Tia) Pham Assistant Professor, Department of Family and Community Medicine, University of Toronto Lead Physician SETFHT and East Toronto Health Link Berlin November 6, 2015

2 As health professionals, we are not the hosts of the care system but guests in our patients lives. Don Berwick, Former CEO, IHI Institute for Healthcare Improvement

3 Outline 1. Health Care Reform in Ontario, Canada Strengthening Primary Care by Building Family Health Teams (FHT). Expanding Primary Care Beyond the Doctor 2. The Organizational Structure of FHTs 3. Lessons to Share from 10 Years of Experience

4 Do Canada and Germany have anything in common? 80 Mil versus 35 Mil people in Canada, 14 Mil in Ontario. Population > age 65 years: 20% in Germany, 15% Canada.

5 The Evidence for Primary Care Barbara Starfield: National health care systems with strong primary care infrastructures have: Healthier Populations Fewer health-related disparities Lower overall costs for health care Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Millbank Q 2005:83:

6 World Health Organization 2008 Primary Health Care Report

7 Family Health Team Facts 2015 First FHTs in 2005 Last in FHTs ~ 2,600 physicians ~ 2,000 interprofessional health providers ~ 25% of Ontarians (> 3Mil) are enrolled in FHTs 3-4% served by salaried models such Community Health Centres and Nurse-Practitioner led FHTs

8 Vision for Ontario s Family Health Teams (FHT) All Ontarians will have timely access to high-quality and comprehensive primary care Care that is informed by the social determinants of health Delivered by the right mix of health professionals, working in collaborative teams, in partnership with patients and the community Anchored in an integrated health system, promoting good health and seamless care for all patients Sustainable

9 The FHT Care Team THE PATIENT works collaboratively with: Care Coordinator Family Doctor Health Promoter Mental Health/Addictions Counsellor Nurse Practitioner Occupational Therapist Pharmacist Physician Assistant Psychologist Registered Dietitian Registered Nurse Respiratory Therapist Social Worker Access to the right service by the right provider at the right 2me

10 Structure and Organization of FHTs 3-25 family physicians, rarely 150 Rostered population ranging from ,000 Capitation based remuneration for physician-led or mixed governance FHTs; salaried physicians in community sponsored FHTs Supported by Information Technology (Electronic Medical Records) Team-based care with a full range of administrative and clinical team members Linked with other community and health services

11 A Concrete Example: SETFHT Medical Doctors 22 Family Physicians 38 Residents 5 Consultant Specialists The Team 22 Interprof Healthcare Providers 15 Administrative Staff Governance 9 board members of which 5 are physicians, 2 are patients, 1 community member 6 Administrative Staff 20,000 Patients living within a Health Link that comprises a local neighborhood of 170,000 people, 1 Community Hospital

12 Ontario s Physician Payment Reform The payment of medical services to clinicians evolved with the change in care models PRIMARY CARE REFORM THEN Capitation Fee for service Group practices physician working in teams compensation Comprehensive care Solo practitioners Episodic care Lack of family medicine graduates NOW More than 10M patients enrolled to a family physician ¾ of physicians are in group practices Family medicine now a desired speciality

13 Integration Collaboration To address the many challenges inherent in health system -service-care integration, solutions must be found on three (3) distinct, but highly interconnected levels: 1- Macro (where policy, financing, and regulation sets the stage) 2- Meso (where provider organizations interact) 3- Micro (where professionals and patients meet in the caring enterprise). Kodner, Health Council of Canada 2012

14 Change is the Only Constant Equitable Access to Interprof Teams, Population Health Management Baker Price Report 2015 Better Coordination of Care for Complex Patients Health Links Ontario, Ministry of Health and Longterm Care 2012

15 Lessons Learned in 10 Years 1. Involve Patients from the Beginning 2. Invest into Leadership Physician Leadership is Important 3. Measure for Quality 4. Build High Performing Teams 5. Share Information Technology Matters

16 Putting Patients at the Centre Model the Way Create a Patient and Family Advisory Board. Hear a family or patient story at each governing board meeting (Conway 2008). Put patients and families on improvement teams as team members. Inspire a Vision Hold listening circles with staff to learn their heart s desire for patients and family. Tap into story telling Adapted from Kouzes and Posner (2007)

17 Effective Board Governance Provides positive force for innovation Sets vision and strategic goals Fiduciary responsibility FHTs exist in 3 types of boards physicians only, mixed, community based only. Involving physicians at the board level instrumental for driving change AFHTO_Fundamentals-of- Governance_Apr14_FINAL.pdf

18 . The Starfield Project: Advancing a Performance-Oriented Model

19 Quality Measures Data to Decisions 2.0 Patient Experience Timely Access to Care Patient engagement in self management Chronic Disease Management Cancer screening rates Immunization rates System Integration Total cost of care per patient 30 day readmissions rates after hospitalization

20 Fiscal Considerations It is not enough for policy makers to establish interprofessional primary care practices. Careful planning is needed in the development of shared work space and supported Electronic Medical Record systems that facilitate easy communication and interprofessional program development. Gocan, Journal of Research in Interprofessional Practice and Education, 2014

21 Benefits of Interprofessional FHT Care Enhanced Access to Care More Holistic Care Increased Efficiency One Stop Shopping Better Coordination Improved Chronic Disease Management High Patient and Physician Satisfaction Gocan, Journal of Research in Interprofessional Practice and Education, 2014

22 Build Effective Teams Effective interprofessional collaboration includes the engagement of two or more professionals from different disciplines who share a common goal shared knowledge multiple interactions over time an understanding of each professional s role supportive organizational culture Legare et al, Journal of Evaluation of Clinical Practice, 2010 Every member works at the max of their scope through protocols and directives.

23 Information Technology Manage Patient Care Do Electronic Medical Records improve Quality? Patient At Home Hospital Clinic Long term Care

24 In Summary: 1. Involve Patients from the Beginning 2. Invest into Leadership Physician Leadership is Important 3. Measure for Quality 4. Build High Performing Teams 5. Share Information Technology Matters

25 What Are the Characteristics of Successful Integrated Care Systems? Physicians play a key leadership role The organizational structure promotes coordination Practice sites provide geographic coverage Movement from physicians working in solo practice to multidisciplinary teams Health plans work in partnership with the system, sharing risk and being actively involved Coddington et al. (1997)

26 More Questions Than Answers? Dr