Healthy People. Excellent Care. One System. Advancing Integrated Health Care Susan Plewes, Director, Health System Transformation in Muskoka; Health Link The District of Muskoka Municipal Council - Community Services Committee February 20, 2013
beinspired Our Mission Together Achieving Better Health, Better Care, Better Value Our Vision Healthy people. Excellent care. One system. Our Values Be Real Be Revolutionary Be Courageous
How our journey to create a better health system began
Imagine a Better Health Care System (2007) 1. Communities that work together to help people stay healthy 2. Fewer people with chronic diseases, and better care for those that have them 3. A health care system that respects Aboriginal culture and helps improve Aboriginal health 4. Being able to get quality care when and where you need it 4
Imagine a Better Health Care System (2007) 5. A health care system focused on patients, clients and their families that supports them across the entire health care system 6. A health care system available to everyone no matter who or what their needs may be 7. A health care system with the team of doctors, nurses, staff and volunteers it needs 8. A health care system with the buildings and equipment needed for quality health 5
Imagine a Better Health Care System (2007) 9. A health care system that only asks people for information once 10. Health care providers treating the same problem in a similar way 11. Health agencies that keep their overhead costs as low as possible 6
Our Person-Centered Approach to Designing the Integrated Health System Individuals who maintain independent living, but interact with the system on an episodic basis. This may include medical, surgical, and/or community services that are aligned to needs from prevention and promotion to supportive care. Population who need a collaborative integrated approach focused on longevity and limiting the progression of disease through health education, prevention, screening, early identification, treatment, and management of chronic health care needs. People who are healthy and able to maintain their health through a self-health management approach or people who feel disconnected from the system. People who are ill and require support from the health system for a period of time People who are living with a lifelong illness or disability People who are coping with complex health needs People who are not actively seeking support from the health system Intermittent People who need immediate assistance from the health system Those with an episodic critical health need that requires immediate attention from a health care provider. People who need active support to maintain their health Interaction with Health System Those who need ongoing support from Primary Care providers. People who require facilitybased services to meet their post-acute health needs through rehabilitation, complex continuing care, long-term care and palliative care to regain health and functional capabilities. Frequent It is recognized that the current system does not effectively respond to marginalized populations e.g. Aboriginal population, people with addictions and mental health needs, children with special needs, homeless individuals, etc. 7
NSM LHIN Integrated Health System Plan 2010-2020
Care Connections Health System Design Objectives 1. Shared vocabulary, principles, framework and a priority setting context for current and future health system changes across NSM that address the unique needs of the residents of each of the LHIN s five geographic planning areas 2. A description of the desired configuration of the LHIN funded and non-lhin funded health system in NSM to 10 years out 3. A multi-year (2010-2020) roadmap to guide short, medium and long term implementation and evaluation of system changes and their respective impacts on health status 4. A structure to support the implementation of recommendations in 12 areas of focus over the first 3 years of the 10 year plan 9
The North Simcoe Muskoka (NSM) LHIN has a population of 447,485 (2009) representing 3.5% of Ontario s population. Teamwork: simply stated, it is less me and more we.
Implementation Structure, Years 1-3 Lead Organizations for each Areas of Focus : Health Service Provider Boards and LHIN Board NSM LHIN Leadership Council GBGH OSMH OSMH Waypoint RVH CGMH 1. Complex & Chronic Health Needs 2. In Home & Community Capacity 3. Maternal Child Health 4. Mental Health & Addictions 5. Medicine 6. Surgery Complex Continuing Care Chronic Disease Prevention and Management Behavioral Support System Alternate Level of Care Home First Senior Friendly (Hospital) Strategy Maternal and Child Health Community of Practice Waypoint Schedule1Beds to community hospitals Building Child & Adolescent Capacity Community Crisis Management LHIN-wide Critical Care System LHIN-wide Integrated Vascular Care System LHIN-wide Emergency Care System LHIN-wide Musculoskeletal Program (Bone and Joint) LHIN LHIN LHIN LHIN CCAC County of Simcoe 7. Communications and Community Engagement 8. Governance 9. Information Communication Technology/eHealth 10. Integrated Health Human Resources 11. System Navigation 12. Transportation More than 40 projects enabling system integration Standardization of Process and Policy Organizational Development Information & Referral Transitions of Care Inter-facility Community Workforce Planning and Education Recruitment and Retention Boards, Councils & Project Steering Committees supported by: NSM LHIN Leadership Council - CEOs & Executive Directors (the Care Connections (CC) Steering Committee) CC Operations Committee ( the Chairs of 12 Coordinating Councils) CC Implementation Team (LHIN Staff as Liaisons for Councils and Project Steering Committees) Coordinating Councils for 12 Areas of Focus Project Steering Committees for > 40 Projects
Enhancing Relationships and Empowering Action Together, we are living our values - trust, respect, integrity, commitment, focus on the person s experience building and expanding our relationships demonstrating commitment to each other and to the people we serve mutually accountable, and this is propelling us forward showing evidence of success improvement in processes and outcomes 12
Do what you can, where you are, with what you have - Teddy Roosevelt
Summary of Findings (Evaluation of Work 2010-12) 231 recommendations - Integrated Health System Plan 17 completed 102 have been initiated, with >50 of these exceeding 50% complete 6 (Near Term); 4 complete, 2 are 75% complete 83 (Short Term); 10 complete, 50 initiated with the majority over 50% complete 103 (Medium Term); 3 complete, 41 initiated with all between 25% and 50% complete 39 (Long Term); 9 initiated 14
Alignment with Annual Health Systems Trends Report, MOHLTC, 2012 Edition Chronic Disease Prevention and Management Sustainability, Productivity, Innovation - Health Care System Mental Health and Addictions Person-centred Coordinated care ehealth and Information Technology Solutions Aging, End-of-Life, and Palliative Care Evidence-informed Practice, Standards, and Policy Public and Population Health Health System Accountability, Transparency and Performance Measurement Disparities in Health Care 15
Our Journey Continues Building Local Capacity and Resiliency
Implementation in Five Geographic Areas of the LHIN Community Engagement with all stakeholders F2F Meetings in June 12 Webinars in October 12 F2F Meetings in Jan/Feb 13 All with Governors, Executive leadership, Front-line staff, and persons with lived experience 17
Ontario Action Plan for Health Care (2012) The action plan has three priorities : Keeping Ontario Healthy Faster Access to Stronger Family Health Care Right Care, Right Time, Right Place 18
Transforming Health Care Ontario s Action Plan Focuses on Changes System redesign shifting how and where services are provided puts the person at the centre of the system and ensures better coordination and collaboration across the system Funding reform changing the way organizations are compensated (based on evidence, volume, and price) will result in providers being more accountable for the funding they receive and the services they provide 19
Health Links Announcement (MOHLTC Dec 2012) Health Links will encourage greater collaboration and co-ordination between a patient's different health care providers as well as the development of personalized care plans. This will help improve patient transitions within the system and help ensure patients receive more responsive care that addresses their specific needs with the support of a tightly knit team of providers. 20
Health Links Announcement (MOHLTC Dec 2012) Each Health Link will measure results and develop plans to: Improve access to family care for seniors and patients with complex conditions. Reduce avoidable emergency room visits. Reduce unnecessary re-admission to hospitals shortly after discharge. Reduce time for referral from primary care doctor to specialist appointment. Improve the patient's experience during their journey through the health care system. 21
Health Links Announcement (MOHLTC Dec 2012) 19 early-adopter communities have been chosen to launch the first Health Links and will submit plans to the Ministry of Health and Long-Term within the next 60 days. Over time, Health Links will be expanded across the province. A Health Link may include family doctors, specialists, hospitals, home care, long-term care and community support agencies. Each Health Link will have one of its providers play a coordinating role. 22
Health Links Announcement (MOHLTC Dec 2012) Each Health Link will work with its LHIN to develop personalized care plans for seniors and other patients with complex conditions, and to increase the number of those patients with a primary care provider. Patients with complex conditions include seniors, those with multiple chronic diseases, and those with mental illness and addictions 23
Health Links Announcement (MOHLTC Dec 2012) A recent study found that 75 per cent of seniors with complex conditions who are discharged from hospital receive care from six or more physicians and 30 per cent get their drugs from three or more pharmacies. Complex patients represent up to five per cent of Ontario s population, but use two-thirds of the health care budget. 24
Shared Leadership Call to Action $900 $800 $700 $600 $500 LHIN HSP Base Funding Increase (in Millions) Base $400 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 Since beginning of NSM LHIN (7 years) increased LHIN funding by $280M ($100M of which for transfer of provincial psychiatric hospital) What improvements have been made? Do we use excuses to describe barriers to success? Does competition still exist? Lots of good ideas, however need more action? What local initiatives are in place to meet needs of your population? 25
Distribution of Top 1% of High Users and Costs
1 % of the Population = Individuals living with complex and chronic health conditions whom interact often with the health system, require more care and often have longer lengths of stay. Ontario s Top 1% of High Users 27
North Simcoe Muskoka s Top 1% of High Users People age 80+ have a higher average cost / person Males seem to use more resources than females Adults between 18-44 years have the highest average costs / person Proportion of high users per population is higher in the Orillia & Area (16.7%), Midland / Penetanguishene & Area (14%), and Muskoka (16.6%) geographic areas. Barrie & Area has the largest number of high users with 39% of the LHIN s high users and 51% of the LHIN s population reside in this geographic area. 28
Action: Leadership Summit -Participation- 25 People Attended from the Following Organizations: Family, Youth and Child Services of Muskoka The District Municipality of Muskoka Simcoe Muskoka District Health Unit Muskoka Parry Sound Community Mental Health Services Community Living South Muskoka HANDS: The Family Help Network YMCA of Simcoe Muskoka Trillium Lakelands District School Board North Simcoe Muskoka Local Health Integration Network One Kid s Place Muskoka Algonquin Health Care 88% of organizations in attendance gave a green light to participating in the development of a collaboration framework for Muskoka. Poverty Reduction of Muskoka Planning Table (PROMPT) North Simcoe Muskoka Community Care Access Centre BLOOM Strategic Solutions - Facilitators 29
Muskoka is Challenged by Growing Social & Health Needs Ontario Works caseload growth highest in Province 2007-2012 ODSP caseload per capita 40% above Provincial Average Pop age 65+ 23% of total (tied for highest with Prince Edward County) Housing wait list growth of 105% in 5 years Growth in Children in Care at FYCSM Personal / family income at 84% Provincial average and dropping (Muskoka tax filers) Health risk behaviour high (smoking, alcoholism) Lower than average educational attainment Family violence data imprecise but points to high risk EDI scores low average and show worrisome pockets in rural areas 30
Who are Muskoka s Priority Populations? Aging population Lone-parent families increase in # lone-parent families, earn less $ Over 1500 children living in low-income situations Renters with housing affordability issues People living alone social-housing needs Young adults ON Works, high unemployment Number of people requiring assistance (OW, social housing, child-care subsidy and other social supports) increasing dramatically 31
Key Findings in Muskoka Readiness for Change; Improvement in Health System to further Build Healthy Communities Leadership apparent Collaboration amongst Community Services well established Community Development and Planning well connected Capacity to manage large projects in place 32
Key Findings in Muskoka Innovative Health Services in place (and need expansion) Family Health Teams (2 in 3 municipalities) NP led Nursing Stations (Rousseau, Wahta) Seniors Outreach Program (MACH) Geriatric Care Model designed New ideas proposed Mobile primary care team Physician Specialist s services (Cardiac, Lung Health) Technology enhancements (IT coordinated system, Tele-homecare, Tele-medicine, etc.) Wellness Centres 33
Continuum of Collaboration Informal and Local Collaboration Formal and Whole Agency Collaboration Communication Cooperation Coordination Coalition Integration Individuals from different disciplines talking together Providers working jointly on lower priorities on a case by case basis Formalized joint working group No sanctions for non-compliance Joint structures created with willingness to sacrifice some autonomy Integration of services, staffing or initiatives between health system partners locally or system-wide and across sectors.
DMM Health Link something for Everyone The District Municipality of Muskoka 35
For Consideration Potential Risks Know resident population, however, health link sized to fit resident population of 60K seasonal up to 180K Health Link investment = 1 year of up to $1M sustainability to be determined Availability and Sustainability of health and social service resources Potential Opportunities Develop new strategy for large visitor population who may require services; new funding formula $ follow the patient Explore gain-sharing many countries have been successful in redistribution of savings Integrated system has proven to attract people to work in communities 36
Next Steps (February/March) If the Community Services Agrees to moving to Next Steps; work with the NSM LHIN to Meet with Core Group of persons willing to participate and take on leadership roles Complete Readiness Assessment & submit to MOHLTC ($75K Grant to develop Business case) Upon approval develop Business Plan and submit to MOHLTC (potential for up to $1M (onetime) for start up investment 2013/14 2014/15) 37
Health System Transformation As we Advance Integrated Health Care in Ontario, We will Be Real, Be Courageous, Be Revolutionary As we take the next steps on our journey!