Dear Members, The Governance for Quality in Primary Care workshops are now accredited by the College of Family Physicians of Canada and the Ontario Chapter for up to 5 Mainpro-M1 credits. Reminder to register in advance for Governance education opportunities available through AFHTO: 1. “Effective Governance for Quality in Primary Care Workshops” being offered free of charge to AFHTO member board members, executive directors and lead clinicians on March 25th and March 30th in Toronto. a. Register for workshop #1 on Wednesday, March 25^th from 10:30am to 4:30pm at the Sheraton Gateway Hotel (Toronto Airport)

b. Register for workshop #2 on Monday, March 30^th from 10:30am to 4:30pm at the Eaton Chelsea Hotel (downtown Toronto)

2. “Governance Webinars” for primary care leaders. There are 3 separate 90 min webinars focused on the Fundamentals of Governance in support of the Accountability Reform Initiative. Each webinar will be offered twice and posted on the AFHTO members only website. Please register in advance – space is limited. A. Register for Session 1 (Feb 18 or 20): Getting Started B. Register for Session 2 (Feb 23 or 27): The Board’s Responsibilities C. Register for Session 3 (Mar 2 or 4): Looking Forward – using good governance to enhance organizational performance

The content covered in the Governance Webinars is separate from the information provided in the Governance for Quality Workshops – please read the details for each to determine which education session(s) best meet your needs!

To: Physician Leaders in all AFHTO member organizations The Ontario Medical Association is currently in the process of consulting with its members on access to interprofessional care to address priority populations. As part of this process, the OMA has shared their preliminary DRAFT of the ‘Integrated Health Network Policy Paper’ to their Section of General and Family Practice and Section of CHC Physicians. Since there is no OMA Section of FHT physicians, OMA asked for feedback from AFHTO’s Physician Leadership Council (PLC). Twelve members of the Council commented and agreed to a collective submission in response to this request. The draft policy paper and the collective response of PLC members were sent to all physician leaders by e-mail. Any member of the OMA is welcome to send in their own response to the OMA by February 23rd if they wish, to Peter.Brown@oma.org.  The OMA has said they will consider this input as they continue to work on this paper, before going to broader consultation on expanding access to team-based care for priority populations. We encourage each of you to read the draft Integrated Health Network Policy Paper and consider submitting your feedback to the OMA as we strive to obtain a collective vision for a strong base of high-quality comprehensive team-based primary care for all Ontarians. If you have any questions about this process of the draft Integrated Health Network Policy Paper please contact Bryn Hamilton.

Feb. 16 – Globe and Mail reports, “Family health teams – which put doctors, nurses, dietitians and social workers in the same office — offer a holistic and convenient approach embraced by patients and doctors alike. Why then is the Ontario government backing away?” In this feature article, journalist Kelly Grant delves into the value of FHTs from the perspective of patients as well as the findings of the recent Conference Board of Canada’s evaluation of the FHT initiative. The article presents the promising benefits of team-based care. It also reports on the associated physician payment models and the challenge of recruiting and retaining other health professionals whose provincially-funded salaries cannot compete with other parts of the health system. AFHTO emphasizes that the real issue for the sustainability of our health system is the TOTAL cost of care to keep people as healthy as possible. Research in BC found that total cost of care is $30,000 for the sickest patients who don’t have a strong primary care relationship and $12,000 when well-supported by primary care. This is why AFHTO members are working to advance measurement and improvement in primary care, with the objective to optimize quality, access and total health system cost of care for patients. In response to this article, a member, Bruyere Academic Family Health Team, sent the following message to their staff:  To all staff, Several people have commented about the Globe and Mail article on Family Health Teams that appeared over the weekend. The commentary in the article gave the impression that the provincial government is moving away from family health teams, likely based upon the Auditor General’s report. We thought that this would be a good opportunity to comment on what our FHT has been specifically doing to achieve the goals of the Family Health Team model. The first thing to point out is that the government concerns about receiving value for what they have invested in the family health teams has been present for quite some time. The widespread use of the FHT model is a relatively new phenomenon for this province so some growing pains can be expected. In our FHT we have undertaken numerous activities that would be very difficult for us to accomplish if we did not have all of the members of our team or the infrastructure that supports us. We have an excellent team of providers  and staff. Access:  Since becoming a FHT in 2006, we have opened a new site (Primrose) and have moved from 4,539 enrolled patients to almost 12,000 across both sites. We continue to try and improve our enrollment numbers, and are taking Ontario patients from Health Care Connect and other sources. In addition, we serve about 4,000 non-enrolled patients for a total of 16,080 patients. We target vulnerable populations, who may have difficulty finding primary care services. Our clerical staff work hard to schedule patients when they wish to be seen and with their appropriate teams. Integration: We continue to work closely with the CCAC and discharging hospitals to deliver seamless care. Our referrals clerks achieve prompt and appropriate referrals to services within the region. Procedures on site: Within the walls of our clinics we provide patients with a very wide scope of primary care services delivered by their most responsible provider, residents and other members of the team.  This includes numerous procedures such as biopsy, excision of skin lesions, endometrial biopsy, IUD placement, and MSK injections that many other family practices have moved away from. Specialty care on site: Our work with integrating shared care has allowed our patients to access a wide scope of psychiatric services, ambulatory gynecology and orthopedic surgery. The latter two services build upon the capabilities that we derive from our MSK clinics and Women’s Procedures clinic. Preventive care: To prevent more serious health issues for our patients in the future, we have teams that provide chronic disease management, therapeutic lifestyle guidance, diabetes management, and smoking cessation. Other members of our Allied Health group provide assistance with dietary management, medication oversight, social work, kinesiology services, and foot care. We encourage patients in self-management and recommended screenings. We are embarking on a FHT wide primary preventive care emphasis this year with plans for activities centred around obesity prevention and physical activity. Outreach: The team based activity that we are engaged in does not stop at our front door. We currently deliver outreach services at St. Mary’s Home, the Bethany Hope Center, Maycourt Hospice and the Mission for men. In addition to the other services, we have other focused practice activities that are designed to assist with our educational mission such as procedures, maternal health and well-baby clinics. Quality: We also have an extremely active continuous quality improvement program that is allowing us to work in a highly reflective manner. As part of this, we are aggressively measuring multiple aspects of our operation to ensure that we are meeting the goals that we have set for ourselves and that we are being good stewards of the public money entrusted to us. One particularly important measurement is our ongoing patient satisfaction survey. What all the data is telling us is that the work that we are doing is helping us to move forward. We are doing well on our prevention targets, we are keeping patients out of the emergency departments and our patient satisfaction levels are high. We continue to be excellent teaching sites for the family physicians and other health professionals of the future, who are provided with many opportunities to learn about the FHT priorities such as collaboration and comprehensive and team based care. The debate about the value of FHTs will continue for quite some time. Debbie and I feel very strongly that we as a group have done, and continue to do, the kind of work that clearly demonstrates that with the right mix of people and resources, it is possible to profoundly improve care delivery and patient outcomes. This is precisely the goal that the FHT model was created to achieve. Regards to all, Jay and Debbie

E-mail sent to EDs of all AFHTO member organizations AFHTO’s Executive Director Advisory Council (EDAC) met on February 10^th. This update provides an overview and highlights key items discussed (scroll below for more information):

• Evolution of Primary Care & Current Context
• Accountability Reform Initiative
• AFHTO Updates
• PHC Branch Meeting
• QIDS Program Update

Evolution of Primary Care & Current Context

EDAC members reviewed a slide presentation that summarizes the current political and stakeholder environment that is shaping and influencing the primary health care change agenda.  Discussions centered around: Physician Services Agreement Once negotiations ended on January 15^th 2015, the Ministry announced a Ten-Point Plan. We are awaiting details with respect to implementation. One of the points — only areas with a high need for physician services will get new Family Health Organisations and Family Health Teams – raised specific concern amongst EDAC. AFHTO will continue to keep all members informed as further details are released. Key reports to be released by Minister MOHLTC’s Expert Advisory Committee on Strengthening Primary Health Care in Ontario – When these findings are released, AFHTO will work with and on behalf of members to identify the potential impacts and opportunities. Home and Community Care Expert Panel – This report included a look at the intersection of primary care and home and community care, and may also have an impact on the delivery of interprofessional primary care. Call for Expressions of Interest (EOI) for Integrated Funding Models – Members asked about an Expression of Interest (EOI) the ministry recently issued for models that will test innovative approaches to integrate funding over a patient’s episode of care, regardless of who is providing the care, or the location where care is provided. Click here for a recording of the ministry’s information session on Integrated Funding Models (1hr 11min). Evolution of Primary Care & Access to Team Based Care The Minister recently announced his Patients First: Action Plan for Health Care. Recent addresses by the Minister and Deputy Minister have focused on person-centredness, system integration, accountability, increasing health and wellness, and ensuring sustainability and quality. The Deputy has also referenced the need to improve access to interprofessional care. Recruitment & Retention This continues to be the area of primary focus for advocacy by AFHTO, in collaboration with AOHC and NPAO. Click here for AFHTO’s latest update.

The Accountability Reform Initiative (ARI)

To date the ARI applies to FHTs only, however the requirement to complete a Governance Compliance Checklist applies to both NPLCs and FHTs. Members reviewed a briefing note provided by the Primary Health Care Branch outlining an analysis of ARI submissions in FHTs and the status of ARI approvals. More than 60% of FHTs applied for ARI, 52% of whom were approved. A number of opportunities for FHTs to strengthen governance practices were highlighted:

• Strategic Planning
• Performance Measure Monitoring
• Risk Management
• General Board Policies

To support members completing the governance checklist and possibly applying for ARI, AFHTO is pleased to be offering a series of free educational webinars to help primary care leaders meet the requirements of ARI and the Governance & Compliance Attestation, and share best practice strategies to improve governance.

AFHTO Updates

AFHTO provided the council with a number of updates, including: Physician Leadership Council (PLC) – The PLC held its inaugural meeting on January 28^th. With 23 physician leaders representing 12 of the 14 geographical regions, this council creates a new platform for physician leaders to advance best practice knowledge transfer, enhance collaborations and to work together to surface operational, governance and other FHT issues. PLC has identified 4 work streams of focus:

• Ministry-FHT Contract Renewal in 2016 & Focus on Manageable, Meaningful Measurement
• Harmonizing FHT Relations and Practices
• Access to Team-based Care
• Governance and Leadership

For a list of members and draft Terms of Reference click here. Members of EDAC noted there are a number of overlapping priority areas for EDAC and PLC resulting in potential opportunities to work collaboratively to enhance the collective impact. ED Resource Toolkit – AFHTO has recently partnered with the Osborne Group and members of the ED Advisory Council to assemble and develop the Executive Director Resource Toolkit. Its objective is to orient new EDs of FHTs and NPLCs to their role and provide all EDs with easy access to a comprehensive collection of tools, resources and templates that will allow them to manage their operations effectively. A recent ‘Request for Feedback’ was circulated to all EDs in AFHTO membership requesting their support in the Toolkit development. Effective Governance for Quality Work Shops – Members were reminded of the two workshops being offered in late March free of charge to AFHTO member board members, executive directors and lead clinicians on Effective Governance for Quality in Primary Care. The workshops are evidence-based training programs for FHTs and NPLCs, delivered by peer leaders and will cover separate content than the 6 webinars being offered in support of the ARI initiative. Click for more information and registration details. Health Links Community of Practice – The Health Link CoP has been re-launched and will hold a kick off meeting for all AFHTO members that are leading Health Links on February 18^th. If your organization is leading a Health Link and you’re not yet on our distribution list, please contact Bryn Hamilton, Provincial Lead Governance & Leadership (bryn.hamilton@afhto.ca).

Meetings with the Ministry’s PHC Branch

The next quarterly meeting between AFHTO and the Primary Health Care (PHC) Branch will be held on March 5^th. EDAC discussed a number of items to be raised with the branch: 2015/16 Annual Operating Plan Submission Package The Interprofessional Programs Unit emailed the FHT and NPLC Annual Operating Plan Submission Packages to all FHTs and NPLCs on February 9^th. Of key interest was the deadline for submission being extended to April 17, 2015 – in accordance with the strong feedback provided by EDAC and NPLC members!   Premise Costs Members commented on the rental increases their FHTs/NPLCs are currently facing and the change in Ministry direction to cover these associated costs.  Members who previously received ministry funding to cover rental increases are now being directed to find the extra money within their current budgets – a difficult task to make such late notice adjustments! There are also further examples of mixed messaging being received from Ministry consultants with respect to making reallocation requests. The PHC branch has been very clear that if members can demonstrate effective use of funding, then all requests will be strongly considered. AFHTO will be taking this message forward to PHC Branch to work together to improve consistent messaging and to identify ways we can better prepare for any significant changes to the way members are funded. OTN A number of members are being faced with the issue of vendors declaring ‘end of service’ for their telemedicine equipment and finding themselves with the financial responsibility to replace this equipment. Without access to a designated funding envelope, renewing OTN equipment is a significant cost burden and places a tremendous amount of risk to patients if access to the equipment or service is compromised. EDAC members agreed that we must work with the Ministry to develop a unified plan and approach to determine if there can be a one-time allocation of funds for assistance with this issue.

QIDS Program Update

Key highlights were presented, in particular, progress toward completing D2D 2.0, to be launched in May. Click here to access the most recent D2D bulletin. The next meeting of EDAC will be held in April. For any further questions, please contact your EDAC representative (click here for list) or:

Click here for the memo from the Chief Medical Officer of Health regarding provincial and international measles activity as of February 11, 2015.

AFHTO is offering free educational webinars for our members over the next few weeks to: 1)      Help primary care leaders meet the requirements in the ministry’s Accountability Reform Initiative and the Governance and Compliance Attestation; 2)      Share best practice and strategies to improve governance; 3)      Identify and address common issues in FHT/NPLC governance.   There are 3 separate 90 min webinars, each webinar will be offered twice and posted on the AFHTO members only website. Please register in advance – space is limited.  See below for webinar details and to register. REMINDER: Registration is also open for the Effective Governance for Quality Workshops.   

Register for one of the sessions below before Friday, March 13, 2015):

• Workshop #1: Wednesday March 25th from 10:30 to 4:30pm
  • Sheraton Gateway Hotel in Toronto International Airport (skywalk connects the hotel to Terminal 3)
  • Workshop #2: Monday March 30th from 10:30 am to 4:30 pm
    • Eaton Chelsea Hotel, 33 Gerrard Street West Toronto, Ontario (Next to Eaton Centre- closest subway station Yonge-Dundas/College)

The Governance for Quality in Primary Care workshops are now accredited by the College of Family Physicians of Canada and the Ontario Chapter for up to 5 Mainpro-M1 credits. If you have any questions, please contact Bryn Hamilton, Provincial Lead – Governance & Leadership (bryn.hamilton@afhto.ca)