What does the Patients First Act mean for Rural Communities? Michael Barrett, CEO South West Local Health Integration Network (LHIN) ROMA Conference January 30, 017
Overview of Today s Presentation 1. Background the Patients First Journey. Local Health Integration Networks (LHINs) in Ontario 3. Key Areas of Change in Local Health Planning Effective Integration through Sub-Regions Clinical Leadership in LHINs Primary Care CCAC-LHIN Integration Linkages between LHINs and Boards of Health
The Patients First Journey To Date First Mandate Letter September 014 Bringing Care Home (Donner Report) January 015 Patients First: Action Plan for Health Care February 015 Patients First: Roadmap to Strengthen Home and Community Care May 015 Province-wide consultation January April 016 Patients First: Discussion Paper December 015 Auditor General Report on CCACs (Phase ) December 015 Auditor General Report on CCACs (Phase 1) August 015 Price-Baker Report May 015 Patients First: Reporting Back on the Proposal to Strengthen Patient- Centred Health Care in Ontario June 016 Patients First Act, 016 Introduction (Bill 10) June 016 Ministers Mandate Letters Released September 016 Patients First Act, 016 Reintroduction (Bill 41) October 016 Patients First Act, 016 Passage December 016 3
Five Goals of Health System Transformation Effective integration of services and greater equity through sub-regions Timely access to and better integration of primary care More consistent and accessible home and community care Stronger ties to population and public health Services that address the needs of Indigenous people 4
How the Patients First Act, 016 Supports Transformation Goals More Effective Service Integration, Greater Equity Timely Access to Primary Care, and Seamless Links Between Primary Care and Other Services More Consistent and Accessible Home and Community Care Stronger Links Between Population & Public Health and other Health Services Legislative enablers Establishment of sub-regions LHIN objects Designation of new health service providers Accountability mechanisms Transfer of CCACs to LHINs Shared services entity to support backoffice functions Formal linkage between LHINs and Boards of Health Establishments of Integrated Clinical Care Committee Primary health care practice info reporting Expanded LHIN governance Establishment of sub-regions Services that Address Needs of Indigenous Communities Across Ontario Ontario is engaging Indigenous partners through a parallel process that will collaboratively identify the requirements necessary to achieve responsive and transformative change. 5
Local Health Integration Networks (LHINs) Established by the Ministry of Health and Long-Term Care in 005 14 LHINs covering 14 geographic regions in Ontario 6
Sub-region geographies LHIN sub-regions are smaller geographies where LHINs will work with partners on a more coordinated and integrated system. Sub-regions have been identified based on Existing patterns of service provision and patient referral patterns Consultation with local health service providers and community partners Building on Health Links coordinated care planning approach to better serve residents with high care needs Subregion A LHIN Subregion B Linkages with Boards of Health Subregion C 7
LHIN sub-regions, southern Ontario 8
LHIN sub-regions, northern Ontario 9
Sub-Region Wills and Won ts LHIN Sub-Regions will Bring together health system and community partners, as well as clinical leadership, at the local level in health system planning and improvement. Enable more focus on assessing population health need and service capacity. Provide health system data and information for the population of the sub-region LHIN Sub-Regions won t Result in more bureaucracy. Sub-regions will utilize existing LHIN staff in more effective ways - no new organizations are being formed. Impede ministry or LHINs obligations to engage with provincial and regional partners and patients. These will continue. Infringe on traditions or established jurisdictions in the planning, delivery or improvement of health services. 10
76 Sub-Regions, by LHIN and population,000 6 Population (in thousands) 1,800 1,600 1,400 1,00 1,000 800 600 400 00 0 6 16 43 59 7 108 11 5 89 114 445 146 157 4 93 145 138 397 6 383 63 111 114 194 55 5 7 10 14 41 9 6 306 319 01 10 9 74 65 5 70 0 76 374 510 143 199 433 306 33 6 7 7 135 89 88 30 435 178 5 14 148 61 13 35 5 197 189 43 63 151 5 5 7 63 34 53 80 140 117 6 103 5 0 18 18 43 11
New Clinical Leadership in LHINs Every LHIN Sub-Region will have a designated Clinical Lead (part-time) who will: Lead local clinical engagement and champion high-quality care Oversee quality improvement and patient safety Support design and implementation of LHIN primary care strategy Participate in local planning tables This Clinical Lead will most likely be a family physician Clinical Leadership will work with local providers and local partners (such as community recruiters in municipalities) on coordinated health workforce planning. New VP Clinical positions will be established in all LHIN to oversee clinical roles and provide leadership in the LHIN senior team. 1
Primary Care: The Case for Change While patient attachment rates have improved in the past decade, significant numbers of Ontarians are still seeking a primary care provider. There is also regional variation in patient attachment, especially in areas with a lower density of primary care providers. Physician retirements can leave thousands of Ontarians unattached to primary care if not properly planned. Percentage of patients that are attached to a regular PCP ON SE NE 94% 98% 85% Difficulty getting same day/next day access 56.5% Having difficulty getting after-hours care 53% Waited five or more days to see their primary care provider Succession planning for primary care practices would allow greater continuity of primary care for patients. 6% Not aware of after-hours services provided 66% 13
LHINs Increasing Role in Primary Care LHINs, in partnership with local clinical leaders, will take responsibility for linking patients with primary care services, health workforce planning, and improving access to inter-professional teams. Primary care models: (ie. Family Health Teams) can now be funded by LHINs (this does not include the physicians) Health Care Connect: LHINs will employ the Care Connectors currently working in CCACs, helping individuals to be matched with a primary care provider Workforce Planning: LHINs recommendations inform the ministry s designation of high needs area for primary care providers. Health Force Ontario regional advisors are co-located with LHIN staff in each LHIN to support workforce planning. No part of the Patients First Act, 016 would change the control that patients currently have over all aspects of their healthcare. Patient choice remains paramount and health care will not be disrupted. 14
14 LHINs 36 Health Units # of LHINs Sharing the PHU LHIN boundaries 15
Geographic overlap between Health Units and LHINs Health Units per LHIN LHINs per Health Unit (+) South West North East 6 7 City of Toronto Grey Bruce 3 5 HNHB South East Champlain Central West Central East 4 4 4 4 5 Leeds, Grenville and Halton Regional Haliburton, Kawartha, Pine Renfrew County and District Waterloo Well. North West Miss. Halt. Erie St. Clair Central N. Simc Musk. 3 3 3 3 3 Haldimand-Norfolk Peel Regional York Regional Wellington-Dufferin-Guelph Porcupine Toronto Central 1 Simcoe Muskoka District 16
Relationships between LHINs and Boards of Health enabled through Patients First Act, 016 A local health integration network shall ensure that its chief executive officer engages with each medical officer of health for any health unit located in whole or in part within the geographic area of the network, or with the medical officer of health s delegate, on an ongoing basis on issues related to local health system planning, funding and service delivery LHINs will incorporate population health approaches in health system planning LHINs will benefit from Public Health s population health assessments for local populations 17
Examples of Areas of Collaboration between LHINs and Boards of Health Health equity impact assessments Community Planning Tables Sub-region population profiles Integrated planning for indigenous health Maternal/child health services planning Falls prevention Diabetes prevention/ chronic disease prevention Planning services for selected cultural and language groups Emergency planning Outbreak response (e.g. Ebola response) 18
Community Care Access Centres Integration with LHINs The Patients First Act, 016 will transfer responsibility for service management and delivery of home and community care from Community Care Access Centres (CCACs) to the LHINs. In the transition, continuity of patient care is a top priority. Transition is scheduled for late spring/summer 017. Goals of the integration: Easier transitions from acute, primary and home and community care and long-term care Clear standards for home and community care Greater consistency and transparency around the province Each LHIN has been mandated to achieve a 8% savings in management and administrative costs in the new organization 19
LHINs: Now and in the Future Linkages with Boards of Health LHINs Plan, Fund, and Integrate the Local Health System LHIN Sub-Regions established Clinical Leadership in place Planning for Primary Care Accountable to LHIN: Hospitals Community Health Centres CCAC Long-Term Care homes Community Support Service providers Mental Health & Addictions providers Home Care Services integrated within LHINs 0
Questions? Michael Barrett, CEO, South West LHIN 1