Service Accountability Agreements Update

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1 Service Accountability Agreements Update Central East Local Health Integration Network Board Meeting Date: December 21, 2016 Presented By: System Finance and Performance Management

2 Overview Context Service Accountability Agreements (SAA); Provincial Refresh and Engagement Structure; Alignment with Health System Priorities; Indicator Classifications; 2017/18 SAA Refresh Process; 2017/18 Hospital Service Accountability Agreement (HSAA) Extension; 2017/18 Long-Term Care Home Service Accountability Agreement (LSAA) Amendment 2017/18 Multi-Sector Service Accountability Agreement (MSAA) Extension 2

3 Context Service Accountability Agreements SAAs are required for all Local Health Integration Network (LHIN) funded health service providers (HSP) under the Local Health System Integration Act, 2006 (LHSIA). A SAA is a legal vehicle that delineates accountabilities and performance expectations, and allows a LHIN to flow funding to an HSP. A SAA is a tool that assists every LHIN to fulfil its obligations - under LHSIA to plan, fund and integrate its local health system (i.e., system management); and - to the Ministry of Health and Long-Term Care (MOHLTC), the Province and the taxpayer in respect of funding (i.e., risk management). The SAA has provisions to support the effective and efficient use of funds, to ensure accountability, to measure the effectiveness and impact of services, and to enable a LHIN to adjust its approach to an HSP or the system in the event that adjustments are necessary. 3

4 Context 2017/18 Service Accountability Agreements In light of on-going LHIN renewal activity across the province and legislative changes, there was a pan-lhin agreement to minimize changes to SAAs this year, which included maintaining current indicator slates for all three SAAs; Simple Amending Agreements are proposed for all three SAAs; Engagements with the health service providers have been undertaken through the use of ed materials, highlighting both the provincial and local perspectives; 2017/18 Schedules will be attached to agreements and reflect 2016/17 3 rd Quarter funding and performance levels; 4

5 Context Service Accountability Agreements (cont d) Hospital Service Accountability Agreement The HSAA Amending Agreement expires March 31, It is intended that the current HSAA will be extended for an additional year, with an expiration date of March 31, LHINs have the option to use existing 2016/17 schedules or issue new 2017/18 schedules. Hospitals are required to submit a Hospital Accountability Planning Submission (HAPS). The Central East LHIN is proposing to issue new schedules, maintaining 2016/17 indicators and targets. 5

6 Context Service Accountability Agreements (cont d) Long-Term Care Home Service Accountability Agreement The current LSAA has been signed for the period April 1, 2016 to March 31, A minor amendment to the LSAA, along with a Schedule refresh has been proposed for 2017/18. No Long-Term Care Accountability Planning Submission (LAPS) is required. It is proposed that a 1-year extension with updated 2017/18 schedules will be executed. No changes to 2016/17 indicators or targets will be introduced. Multi-Sector Service Accountability Agreement The current MSAA was executed on April 1, 2014 and expires March 31, year extension to March 31, 2018 has been proposed. LHINs were given the option of refreshing with 2016/17 data or refreshing with 2017/18 data. In both scenarios, HSP would be required to submit a Community Accountability Planning Submission (CAPS). The Central East LHIN refreshes its agreements quarterly and therefore opted to refresh with 2017/18 data. 6

7 2017/18 SAA Refresh Process Deliverable Issuance of notice to HSPs (CAPS and HAPS) Annual Accountability Planning Submission materials sent to HSPs (HAPS & CAPS) Timeline 60 days in advance of approved Accountability Planning Submission Mid-October 2016 Pan-LHIN SAA schedules and indicators education sessions October/November 2016 Annual Accountability Planning Submission completed and uploaded November 21, 2016 HSP education session on indicators and targets October/November 2016 Central East LHIN Board approves templates and delegates authority December 21, 2016 HSP Boards approve final CAPS January 31, 2017 Review of Accountability Planning Submissions, negotiations, meetings November 2016 Mid-February 2017 Schedules issued February Mid March 2017 HSP Board approval of schedule amendments and/or SAA; returned to the LHIN by March 18 Central East LHIN Board presentation of 2017/18 SAA schedule amendments/issues February 24 March 18, 2017 February / March, 2017 Refreshed/new agreements executed by CEO and Chair March 31, /18 refreshed/new SAAs come into effect April 1,

8 2017/18 Hospital Service Accountability Amending Agreement & Schedule Refresh

9 2017/18 HSAA Process: Assumptions/Negotiations Common assumptions established in consultation with Hospital Chief Financial Officers: - All hospitals must balance; - Current ratio trend must be increasing; - Hospital funding increase will remain at 2016/17 levels; - Quality-Based Procedure (QBP) and Health Based Allocation Model (HBAM) impacts are unique for each hospital; and - Hospitals must minimize service impacts. All hospitals have submitted their 2017/18 HAPS, including identification of pressures and mitigation strategies. Considerations to The Scarborough Hospital (TSH) / Rouge Valley Health System (RVHS) amalgamation and Lakeridge Health (LH) / RVHS asset transfer are taken into account - preliminary HAPS do not include integration costs to be addressed within the next 60 days. LHIN staff continue to negotiate 2017/18 targets, volumes, and indicators. Any deviations from negotiation criteria will be highlighted at a subsequent LHIN Board meeting. 9

10 2017/18 HSAA Schedules: Changes Schedule A (Funding) Under Wait Time Strategy Service (Section 3), incremental funding has been removed to reflect the current approach, which reflects allocation through base funding only. Under QBP (Section 2), the list of QBPs has been updated to reflect the refined list of QBPs noted in the HAPS Guidelines. 10

11 2017/18 HSAA Proposed Amending Agreement Template - (Appendix A) French version available upon request 11

12 Next Steps Request that the Central East LHIN Board delegate authority to the Central East LHIN Chief Executive Officer (CEO) to negotiate HSAA targets, volumes, and obligations as described; and Provide an update on the status of negotiations at the February and March Board meetings. 12

13 Questions/Discussion Motion 13

14 Long-Term Care Home Service Accountability Agreement Amendment and 2017/18 Schedules Refresh

15 2017/18 LSAA Schedule Refresh: Process No 2017/18 LAPS is required. All indicators and targets will remain unchanged. Section 6.2 of the LSAA, Community Engagement and Integration Activities, reads: (c) Reporting. The HSP will report on its community engagement and integration activities as requested by the LHIN and in any event, in its Q4 Performance Report to the LHIN. The LHINs no longer require LTCHs to submit the Q4 Performance Report. It is recommended that this reference be removed from the LSAA through the use of an amending agreement. 2017/18 Schedules will be refreshed with minor updates. 15

16 2017/18 LSAA Schedule Refresh: Summary of Changes Description of Changes Schedule A No Changes Schedule B No Changes Schedule C Removed Reference to requirement to submit QIP to LHINs (in addition to HQO) Schedule D Updated relevant dates Schedule E No Changes 16

17 2017/18 LSAA Schedule Refresh: Proposed LSAA Amending Agreement Template (Appendix B) French version available upon request 17

18 2017/18 LSAA Schedule Refresh: Proposed LSAA Amending Agreement Template (cont d) 18 18

19 Questions/Discussion Motion 19

20 2017/18 Multi-Sector Service Accountability Amending Agreement & Schedule Refresh

21 2017/18 MSAA Refresh: Process In order to retain the integrity of the existing MSAA agreements and 2016/17 Schedules, which are both LHIN Board and HSP board approved, the LHINs, at their discretion, will have two options for consideration for renewal of the SAA Agreements: - Option 1) Update the Full CAPs for all MSAAs; - Option 2) Only update the CAPS when: new funding was received by the HSP during the 2016/17 operating year; and/or the HSP has undergone or is in the process of an integration; and/or there are changes to the HSP expenses or performance targets; and/or there have been significant changes to the organization (e.g., change in leadership, change in location for providing services, labour dispute); and/or other LHIN criteria for a materiality assessment. 21

22 2017/18 MSAA Refresh: Process HSP budgets must represent the latest funding and activity represented in the 2016/17 3 rd Quarter MSAA Refresh. All variances not consistent with the MSAA refresh assumptions must be accompanied by a Service Delivery Change Request Form. - The process for managing Service Delivery Change Requests will be consistent with the process employed during and following the 2015/16 refresh including: Standard documentation and analysis; Meetings with providers as required; and Progressive approvals based on the nature of the requests, approvals are managed at the most appropriate level. 22

23 2017/18 MSAA Refresh: Criteria for Review/Negotiation Balanced Budget: HSP must balance based on an assumption they will receive a 0% base funding increase; Expenses at the Functional Centre (FC) level: HSP must balance based on an assumption they will receive a 0% base funding increase; Activity at the FC level (e.g., individuals served, visits): Unless an HSP receives approval of a Service Delivery Change Request to alter activity in one or more FCs, volumes must either increase or remain within the defined performance corridor as compared to 2016/17 (latest refresh); and New base funding: Activity targets are established for any new base funding for 2017/18, benchmarked with provincial counterparts, and based on planning and negotiations. 23

24 MSAA Schedules Refresh: Recommended Changes Schedule Change Rationale A and B Added applicable dates for 2017/18 Updated to reflect 2017/18 C Added applicable reporting dates for 2017/18 Updated to reflect applicable 2017/18 reporting periods New requirement for HSP to submit both Electronic Audited Financial Statements will help paper copy Board Approved Audited expedite the settlement process Financial Statements, to the Ministry and the respective LHIN where funding is provided; soft copy to be uploaded to SRI D - CCAC Added: 2014, 2015, 2016 Addendum to Directive to LHINs: Personal Support Services Wage Enhancement Removed: CCAC Client Services Policy Manual (2007) Directive Addenda added as a reference to LHINs. LHINs are already aware of these items. Policy Manual is outdated 24

25 MSAA Schedules Refresh: Recommended Changes (cont d) Schedule Change Rationale D CHC No change D CSS D CMH&A Added: 2014, 2015, 2016 Addendum to Directive to LHINs: Personal Support Services Wage Enhancement Added: Addictions staged screening and assessment tools (2015) Updated: Early Psychosis Intervention Standards (March 2011) Removed: Ontario Admission Discharge Criteria for Addiction Agencies (2000) Admission, Discharge and Assessment Tools for Ontario Addiction Agencies (2000) 25 Directive Addenda added as a reference to LHINs. LHINs are already aware of these items. New for 2015 Updated to reflect current document version. Replaced by Addictions Staged Screening and Assessment Tools (2015)

26 MSAA Schedules Refresh: Recommended Changes (cont d) E Schedule Change Rationale No change F No change G Added applicable period Updated to reflect the applicable period 26

27 2017/18 MSAA Amending Agreement Template Proposed Changes - (Appendix C) French version available upon request 27

28 2017/18 MSAA Schedule Refresh: Next Steps Negotiate MSAA agreements based on the identified criteria; Based on delegated authority, the Central East LHIN CEO and Chair will execute refreshed agreements prior to the next Board meeting if the identified criteria are met; Central East LHIN staff will prepare a report on all executed MSAA agreements; and For any agreements not executed, the report will include details of any issues, including mitigation strategies and recommendations. 28

29 Questions/Discussion Motion 29

30 Appendix

31 Service Accountability Agreements Update

32 Provincial Refresh and Engagement Structure SAA Advisory Committee (HSAA, MSAA, LSAA) SAA Indicators Work Group (HSAA, MSAA, LSAA) SAA Planning & Schedules Work Group (HSAA, MSAA, LSAA) Self-Reporting Initiative Forms Workgroup (HSAA, MSAA) SAA Indicator Support: Health System Indicator Initiative (Now retired) SAA Legal Counsel Support: LHIN Legal Services Branch SAA Secretariat/Project Management Support: LHIN Collaborative (LHINC) Local SAA Implementation: LHIN SAA Leads 32

33 Provincial Refresh and Engagement Structure Each SAA Advisory Committee oversees and provides advice to the development of the SAA template agreement, schedules and agreements. The Advisory Committees are chaired by one of three LHIN CEO Co-Chairs. In the case of the HSAA, the Ontario Hospital Association works directly with the LHINs to oversee the process. Membership on most Committees and Work Groups includes representation from: - LHINs; - MOHLTC; - Health Quality Ontario (HQO); - Long-Term Care Home Associations (Ontario Long-Term Care Association [OLTCA]), - Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS); - Ontario Hospital Association (OHA); - Ontario Medical Association (OMA); and - Association of Municipalities of Ontario (AMO). 33

34 Provincial Refresh and Engagement Structure (cont d) SAA Indicators Work Group is responsible for preparing indicator recommendations and for developing SAA indicator-related target setting documents and education materials. Planning and Schedules Work Group is responsible for: - developing the Accountability Planning Submission HAPS; CAPS; LAPS; - guidelines; - education materials; and - frequently asked questions (FAQs). 34

35 Alignment with Health System Priorities MOHLTC: Patient s First: Action Plan for Health: Access providing faster access to the right care; Connect delivering better coordinated and integrated care in the community, closer to home; Inform providing the education, information and transparency needed to make the right decisions; and Protect making decisions based on value and quality. LHINs: Pan-LHIN Health System Aims: Transform the patient experience through a relentless focus on quality; Tackle health Inequities through a focus on population health; and Drive innovation and sustainable service delivery. 35

36 Alignment with Health System Priorities (cont d) LHINs: Pan-LHIN Health System Aims: Build and foster integrated networks of care in and across each LHIN in the following priority areas: Mental Health and Addictions Services; Health Links or LHIN Sub-Regions; Home and Community Care; Long-Term Care Redevelopment; and End-of-Life / Palliative Care Provincial Strategy. Hospital, Community and Long-Term Care Sector Advancement of Pan-LHIN health system imperatives; Advancement of the LHIN s Integrated Health Service Plan (IHSP); Sector-specific performance indicators; and Build and foster integrated networks of care in and across each LHIN in the following priority areas. 36

37 Indicator Classifications Performance Indicators May trigger consequences under the SAA; Associated with a target and corridor, or, at minimum, have a benchmark; and Are valid, feasible measures of system performance. Explanatory Indicators Complementary to performance indicators; Support planning, negotiation or problem-solving at the provincial or LHIN level; and Will not trigger consequences under the SAA. Developmental Indicators Require further validation to ensure quality criteria (e.g., validity) are met prior to moving the indicators to performance/explanatory status; and Not included in the SAAs. LHIN-Specific Indicators/Obligations These typically support the LHIN s local goals and may be expressed as an obligation or an indicator with a target. 37

38 2017/18 Hospital Service Accountability Amending Agreement & Schedule Refresh

39 2017/18 HSAA Process: Common Indicators Balanced Budget: All hospitals must balance based on a 0% increase assumption; Current Ratio (Consolidated); Total Margin (Consolidated); Volume Indicators: Volumes must either increase (where appropriate) or remain consistent with 2016/17 targets (any proposed changes must be supported by a Service Delivery Change Request form); Wait Time Targets: Percent Complete within Priority 2, 3 and 4 Access Targets; Hospital Targets will be aligned to the LHIN Ministry LHIN Accountability Agreement (MLAA) targets, including; - 90th Percentile Emergency Department (ED) length of stay for Complex Patients (now a combination of admitted and non-admitted complex); and - 90th percentile ED Length of Stay for Minor/Uncomplicated Patients. Rate of Hospital Acquired Cases of Clostridium Difficile Infections; and Alternate Levels of Care (ALC) Rate (Updated Technical Specifications). 39

40 2017/18 HSAA Process: LHIN-specific Indicators/Obligations Repeat Unscheduled Emergency Visits Within 30 Days for Mental Health Conditions (%) (explanatory in MLAA); Repeat Unscheduled Emergency Visits Within 30 Days for Substance Abuse Conditions (%) (explanatory in MLAA); Resource Matching and Referral Initiative; ED Pay-for-Results Program; Diabetes Education Program Funding (activity targets vary by provider); % of Palliative Care Patients Discharged Home With Support; Readmissions within 30 days for Selected Health Based Allocation Model (HBAM) Inpatient Grouper (HIG) Conditions; Orthopaedic Quality Indicator Hip & Knee Replacement Average Length of Stay (days) (explanatory in MLAA); and Orthopaedic Quality Indicator Hip & Knee Replacement Proportion of Patients Discharged Home (%) (explanatory in MLAA). 40

41 2017/18 HSAA Process: Proposed LHIN-specific Obligations Performance Obligations To better serve the increasing number of Franco-Ontarians, Indigenous people and new Ontarians, the Central East LHIN will support the advancement of a health care system that is capable of delivering the highest-quality care at the local level to any patient, regardless of race, ethnicity, culture or language capacity. HSP will be required to report back to the Central East LHIN as requested on programs and initiatives that demonstrate their commitment to this priority. Each HSP must be a signatory to the Health Link Letter of Commitment as provided by the Central East Local Health Integration Network (Central East LHIN). Central East LHIN s Regional District Stroke Centres (Peterborough Regional Health Centre (PRHC) and LH) will be accountable for four stroke indicators and targets based on the Ontario Stroke Network s Central East LHIN Report Card. Each HSP must submit a balanced or surplus operating position, where the Total Margin calculation includes all sectors and fund types, including amortization. 41

42 Long-Term Care Home Service Accountability Agreement Amendment and 2017/18 Schedules Refresh

43 2017/18 LSAA Schedule Refresh: Performance Indicators and LHIN-specific Obligations Provincial Performance Indicators Total Margin; and Debt Service Coverage Ratio. LHIN-specific Obligations Behavioural Supports Ontario (BSO) Indicators: All LTCHs are required to comply with the reporting requirements established for the provincial BSO program. Response Time to Application: The LTCH will ensure that the response time to application is within the legislated time frame in order to support efficient system flow and placement. The obligation to become accredited within the 3-year term of the LSAA be eliminated based on the assumption that LTCH will continue to maintain accreditation status, once the initial investment has been made. 43

44 2017/18 Multi-Sector Service Accountability Amending Agreement & Schedule Refresh

45 2017/18 MSAA Schedule Refresh: Performance Indicators Core Performance Indicators All Sectors Proportion of budget spent on administration; Percentage variance forecast to actual expenses; Fund type 2 (i.e., LHIN funding) balanced budget; Percentage total margin; Service activity by FC; Variance of forecasted to actual units of service; Number of individuals served; Percentage ALC days; and ALC Rate (New to the MSAA). 45

46 2017/18 MSAA Schedule Refresh: Performance Indicators Performance Indicators Community Care Access Centre (CCAC) Wait time from Hospital Discharge to Service Initiation (Hospital Clients) (90 th and 50 th Percentile); Wait time for Home Care Services Application to First Service (Community Setting) (90 th and 50 th Percentile); Percentage of adult home care patients who received their first nursing visit within five days of the date they were authorized for nursing services (moved from explanatory); and Percentage of adult home care patients with complex needs who received their first personal support visit within five days of the date they were authorized for personal support services (moved from explanatory). 46

47 2017/18 MSAA Schedule Refresh: Performance Indicators Performance Indicators Community Health Centres (CHC) Cervical cancer screening; Colorectal screening rate; Inter-professional diabetes care rate; Breast cancer screening rate; Retention rate (for Nurse Practitioners and General Practitioners); Influenza vaccination rate; and Access to primary care. 47

48 2017/18 MSAA Schedule Refresh: Proposed LHIN-specific Obligations Obligations To better serve the increasing number of Franco-Ontarians, Indigenous people and new Ontarians, the Central East LHIN will support the advancement of a health care system that is capable of delivering the highest-quality care at the local level to any patient, regardless of race, ethnicity, culture or language capacity. HSP will be required to report back to the Central East LHIN as requested on programs and initiatives that demonstrate their commitment to this priority. Each HSP must be a signatory to the Health Link Letter of Commitment as provided by the Central East LHIN. In addition, it is proposed that 2 explanatory obligations regarding the identification of complex vulnerable patients and the process for developing Coordinated Care Plans will be added. Community Mental Health and Addiction Services (CM&A) Repeat unscheduled emergency visits within 30 days for mental health conditions; and Repeat unscheduled emergency visits within 30 days for substance abuse conditions. 48

49 Questions? Discussion

Multi-Sector Service Accountability Agreements (M-SAA)

2011-14 Multi-Sector Service Accountability Agreements (M-SAA) CE LHIN Board of Directors Meeting March 23 rd, 2011 The 2011-14 M-SAA Required under LHSIA and Ministry-LHIN Performance Agreement (MLPA),