Systemic Treatment QBP Level 4 Funding Working Group AUGUST 21, 1-3PM

Systemic Treatment QBP Level 4 Funding Working Group AUGUST 21, 1-3PM

Working Group Regional Members Region Facility Name Erie St. Clair Windsor Regional Hospital Elizabeth Dulmage Erie St. Clair Chatham-Kent Health Alliance Nancy Snobelen South West London Health Sciences Centre Brenda Fleming South West Listowel Wingham Hospital Alliance Karl Ellis South West Woodstock General Hospital Fatima Vieira Cabral Waterloo Wellington Wellington Health Care Alliance Rob Young Waterloo Wellington Grand River Hospital Donna Van Allen Waterloo Wellington Guelph General Hospital Jenna Ruttan Central West Trillium Health Partners Sarah Banbury Central West Headwaters Health Care Centre Shelley O'Grady Central West Trillium Health Partners Viannie Lee South East Kingston General Hospital Kardi Kennedy South East Lennox and Addington County General Hospital Tracy Kent-Hillis Champlain The Ottawa Hospital Donna Leafloor Champlain Renfrew Victoria Hospital Randy Penney Champlain The Ottawa Hospital Cathy DeGrasse North Simcoe Muskoka Royal Victoria Hospital Carole Beals North Simcoe Muskoka Orillia Soldiers' Memorial Hospital Lesley Wesley North Simcoe Muskoka Royal Victoria Hospital Tracey Keighley-Clarke North East West Parry Sound Health Centre Anne Litkowich North East Manitoulin Health Centre Vicky Joncas North East Health Sciences North Natalie Aubin North West Riverside Health Care Facilities Inc. Laurie Lundale North West Thunder Bay Regional Health Sciences Centre Andrea Docherty 2

Agenda Background Principles Refining the L4 Funding Model Approach Working Group TOR Service Level and Financial Workbook Timelines Communications Approach Additional Feedback and Next Steps 3

ST QBP Model Principles The Systemic Treatment funding model should achieve the following objectives/adhere to the following overall principles: Improve quality of care by aligning funding to defined best practice Be patient-centered and ensure that funding follows the patient Promote equitable access to patient care services Promote fair and equitable funding allocation to institutions Promote value for money and improve efficiency (i.e., track and evaluate money spent by outcomes achieved) Promote access to clinical trials where appropriate Support new models of care development Align funding framework with Ontario s Excellent Care for All Act & Patient- Based Payment policy Improve outcome measurement and accountability for reported outcomes Align physician funding & incentives with funding provided to organization 4

ST QBP Model Principles The following principles should guide the development and implementation of the new systemic treatment funding model: Strive for a balance between reasonable and perfect Ensure model development process is transparent, multi-disciplinary, collaborative and evidence guided Balance implementation of new funding model with financial risk to organizations Ensure that the ongoing governance structure (including clinical oversight) is supported by transparent dispute resolution processes Establish ongoing monitoring, reporting and evaluation of processes/outcomes Establish recognized and transparent performance management cycle Prevent sudden and significant annual changes to funding 5

Background STFM Level 4 Working Group Phase 1: Determined that significant variation exists in regional models: services provided, data collection and data quality at level 4 facilities Determined that it was not feasible to establish a minimum threshold for treatment volumes due to limited literature and that CCO should instead identify minimum quality requirements (work in progress) Established a preliminary funding approach Identified language to be included in host hospital level 4 agreements Year 1 STFM Funding Approach Summary: All L4 facilities are funded through the host hospital at a rate of $300 per treatment visit (S1) This rate includes an adjustment to account for non-chemotherapy treatment clinic visits S1 metric reported by all L4 facilities See next slide for more detail 6

Per Treatment Visit Rate The following is included in the per-treatment visit calculated rate: Average cost of treatment (across all regimens) Nursing, pharmacy workload Manager/clerical costs Non-NDFP drug funding The price was then adjusted to account for non chemotherapy-treatment activities: Clinic visits Sundry/admin clinic costs Infrastructure components Future unbundled items- hydrations, infusions, transfusions etc., 7

RCC/L4 Funding Flow Funding will be provided once for an episode of care by CCO to the RCC Funding will flow from the RCC to the Level 4 facility EXAMPLE Patient comes to RCC for consult Patient starts course of treatment and has 6 treatments at L4 facility Patient has 6 months of palliative treatment (1 visit each month) at L4 CCO funding to RCC RCC Receives Consult Bundle RCC received funding for relevant band of the regimen for course RCC receives funding for relevant band for 6 months + Re-consult Bundle RCC funding to L4 Of the RCC funding, RCC provides 6 X treatment rate to L4 facility Of the RCC funding, RCC provides 6 X treatment rate to L4 facility 8

Feedback on the L4 Approach Feedback from Regions Regarding Funding Approach: Funding approach does not adequately address the full scope of activities occurring at L4 facilities, including visits related to oral chemotherapy, supportive care visits, and clinic visits Small facilities are challenged to operate within the funding model because of insufficient resources Other Feedback Regarding Regional Level 4 Models: The STFM has engaged in conversations regarding how L4 facilities function within regional models, including referral patterns, training, education, HHR, RCC support, etc. Working groups have been launched in some regions to consider how best to address the working relations and funding of L4 facilities at the regional level High level of interest in provincial level 4 work Inconsistencies between L4s in understanding data flow Do Working Group members have additional feedback? 9

Level 4 Working Group Why a Reconstituted Working Group? Ensure broader input from all regions with L4 facilities Refine funding model based on additional data gained from the service-level costing workbook Governance The Working Group will advise on the L4 funding approach and those recommendations will be presented to PLC and ultimately the executive sponsors Leadership Chairs: Mark Hartman (RVP) and Irene Blais (Funding Unit Director) Clinical Lead: Dr. Bill Evans Membership: Up to 3 members from each region with L4 facilities Meetings: 3-4 additional meetings Do Working Group members have additional feedback on the Terms of Reference? 10

Refining the Level 4 Funding Strategy: Goal GOAL: ensure that safe care closer to home is appropriately supported through the systemic treatment funding model The Level 4 Working Group will work collaboratively to provide recommendations on potential refinements to the funding model including: Advising on whether multiple funding triggers are required. Potential examples include: Treatment visits (IV vs. non-iv and supportive treatment) Clinic visits Procedures and services Advising on approach for funding required resources to manage level 4 facilities Advising on whether level 4 facilities require different funding levels dependent on volume, treatments and services provided or other factors to be determined Advising on communication approaches to level 4 sites Addressing other issues related to level 4 funding as they arise 11

Refining the Level 4 Funding Strategy: Approach Understand activity, variation and costs across level 4 facilities and develop recommendations for a revised L4 funding strategy. Recommendations will be guided by results of Service Level and Financial Workbook and feedback from Level 4 Working Group. Service Level and Financial Workbook was piloted with North West LHIN and will be expanded across all regions. Lesson learned: necessary to hold one on one calls with each facility Purpose of workbook: To understand service models at each facility To enhance L4 s understanding of data flow from L4 RCP CCO To reconcile available data To allow CCO to understand regional variation i.e. what activity is actually taking place (treatment, clinic visits, procedures, etc.) vs. what activity is being reported To understand costs Facility to confirm accuracy and that data is reflective of systemic treatment patients only Do Working Group members have feedback on the proposed approach? 12

Service Level and Financial Workbook Tab 1: Explanation of data flow - Region specific (Northwest example below): Data available in iport Data is entered at the point-ofcare by Regional Partner Site into the MOSAIQ system (RN MAR and visit capture in Mosaiq for all chemotherapy orders) Thunder Bay accesses regional partner site data and through weekly QA process ensures all orders are reconciled and completed by location Thunder Bay extracts data into an ALR file submission (.CSV) and uploads to web-based application File goes through several stages of sequential error checking & if passes is retained by CCO for processing Facility-specific S1 Metric volumes included in STFM Monthly Operational Report 13

Service Level and Financial Workbook Tab 2: Explanation of ALR metrics & Definitions C2S: Follow-up visits S1: Systemic Suite Visits Antineoplastic Parenteral Treatment S5: Systemic Suite Visits Supportive Agents S7: Systemic Suite Visits Transfusion Therapy S9: Systemic Suite Visits Hydration S11: Systemic Suite Visits Venous Access Device and Line Care S15: Total Systemic Suite Visits S17: Systemic Suite Visits Oral Antineoplastic Treatment S19: Total Antineoplastic Systemic Treatment Visits Tab 3: Facility L4 data CCO will provide a summary of all 2014/15 data and Q1 2015/16 data 14

Service Level and Financial Workbook Tab 4: Statistical Reconciliation Comparison of ALR C2S (Clinic visits) vs. Total MIS Visits based on SR28 OHRS/MIS: Ontario Healthcare Reporting Standards / Management Information System SR28: Service Recipient 28: identified cancer patients Comparison of ALR S1 (total antineoplastic treatment visits) vs. NACRS with main diagnosis= Z511 NACRS: National Ambulatory Care Reporting System Z511: Chemotherapy Session for Neoplasm CCO will provide all data with an explanation of how data compares to various elements including ALR data including patient-level data Facility action: facility asked to review and identify sources of discrepancies 15

Service Level and Financial Workbook Tab 5: Financial Data CCO received data from MOHLTC for both hospital-specific OHRS and OCDM CCO will populate workbooks and facilities are asked to confirm accuracy and that data is reflective of systemic treatment patients only Includes Revenues and Expenditures OHRS: Ontario Hospital Reporting Standards OCDM: Ontario Case Distribution Methodology Includes Performance Metrics to be used for benchmarking Tab 6: Procedures and Services Survey Facilities complete survey with volumes for which procedures and services take place at L4 facilities Do Working Group members have feedback on Workbook components? Would additional guidance or clarity be helpful? 16

Service Level and Financial Workbook Proposed approach: Regional call with all Level 4s and RCCs to confirm approach for the region Individual calls with each facility, CCO and RCC- workbook provided min.1 week in advance Facility provided 4 weeks following call to provide feedback Follow-up calls may be needed Results summarized provincially and per region Do Working Group members have feedback on the approach? 17

Timeline RVP/RD Call Facility calls (guided by workbook) WG meetings. 4 & 5: Develop recommendations July 2015 Sep-Dec 2015 Jan-Feb 2016 Aug 2015 Dec 2015 Feb 2016 WG meeting. 1 Review work plan & workbook WG meetings. 2 & 3 Review results of facility consultations Present results to Advisory Committee + PLC 18

Communications Approach Communication 1: Briefing Note + Webinar to explain the approach and what to expect during facility call? Communication 2: Level 4 in-person session/otn to discuss outcomes and gather further feedback? Communication 3: Revised Funding Approach Briefing Note + Webinar? 19

Discussion: Communication Approach General Feedback: Has the correct frequency of communication been identified? At the right time points? What should be the communication mechanism? Briefing Note? Webinar? Should we plan an in-person/otn session? Communication #1: What do you view as the key messages for the first communication? 20

Additional Feedback and Next Steps Does the Working Group have additional feedback? Next Steps 1-2 meetings scheduled in early December to review results from facility calls 1-2 meetings scheduled in January/February to develop recommendations Or one in-person meeting instead of the above teleconferences? Develop communication #1 and share with Working Group Members for feedback Begin populating workbooks 21