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  • AFHTO 2015 Conference: deadline to join working groups April 7

    Thank you to all those who’ve volunteered to be a part of our working groups so far. We’ve received a truly gratifying number of responses; however, there is still space in a few select groups. Sign up to any of the groups below before April 7, 2015: 1. Population-based primary health care:  planning and integration for the community 4. Building the rural health care team: making the most of available resources 6. Leadership and governance for accountable care 7. Clinical innovations keeping people at home and out of the hospital (Click here for descriptions) You’re also invited to inform any colleagues, staff and patients you think might be interested so they have the opportunity to lend their expertise to the conference program.  

  • Physician Leaders focus on Demonstrating Value, Optimizing Capacity & Strengthening Governance/Leadership

    To: Leaders in all AFHTO member organizations In the words of Dr. Sean Blaine, chair of AFHTO’s Physician Leadership Council (PLC), the three key points from the March 29th PLC meeting of are:

    1. Despite the recent breakdown of MOHLTC / OMA negotiations and the imposition of unilateral action by government, we as physician leaders in FHTs know there is more work to be done to guide the continued transformation of the primary care system. As champions of innovation in primary care, we want to help lead these changes.
    2. There is a need for demonstrating and assuring value in primary care – AFHTOs D2D project has helped to make this more attainable for the broad range of FHTs in the province.  Choosing Wisely Canada is another initiative that has many merits and deserves our attention.
    3. The impending release of the Price Report (Expert Panel on Primary Care) will likely have profound implications for primary care and the possible transition to a more regional/geographic population-based approach to primary care through organized accountable networks. We are ready to lead once these announcements come our way.

    This e-mail summarizes PLC’s discussion:

    • What’s ahead for Team-Based Primary Care
    • PLC’s Priority Objectives
    • Demonstrating & Assuring Value
      • Advancing Manageable, Meaningful Measurement: Role of Physician Champions
      • Choosing Wisely Campaign
      • Optimizing Team Capacity
        • Access to Team Based Care
        • Physician Entry Restrictions
        • Harmonization
        • Strengthening Governance & Leadership

    What’s Ahead for Team-Based Primary Care

    PLC members reviewed recent Ministry announcements and key messages, including an email summarizing Associate Deputy Minister Susan Fitzpatrick’s meeting with the AFHTO board on March 3, and a summary of what’s ahead for primary care in Ontario based on a March 5th meeting between AFHTO’s representatives and the PHC Branch. The following 3 key messages were highlighted:

    “Comprehensive regionally governed, population-based primary health services for Ontarians.”

    This statement has appeared on slides used by both the Deputy and the Associate Deputy Ministers – the intent is clear, but not much more is known at this time.  In his March 9 speech, the Deputy emphasized the critical need for a strong foundation of primary care, and went further to speak of a “possible move to Accountable Care Organizations as our primary care system strengthens.”

    Review of primary care team models

    AFHTO’s March 3 email also reported the ministry will be reviewing the team-based models from the perspectives of performance and accountability, funding, and use of interprofessional teams (recruitment and retention, ratios of team members, opportunity to leverage these resources). The ministry is developing terms of reference for this review, and is considering the range of team-based models to be included. One of the ministry’s drivers is to ensure that Ontarians who could benefit most from team-based care have access to this. The review is still in early development but the PHC Branch confirmed that AFHTO and related associations will be involved to inform the review process.

    Process for determining “high needs” areas / replacement of FHO+FHN physicians

    The ministry has communicated changes to primary health care physician payments, such that, “effective June 1, 2015 and onwards, monthly registration into these models will be limited to 20 physicians per month in areas of high need.” By end of March, the ministry is aiming to have the criteria and process in place for determining “areas of high need”. LHINs will be playing a key role.

    PLC Priority Objectives

    In light of the recent Ministry announcements and direction, members agreed on the following 3 priorities for their work:

    • Demonstrating & Assuring Value
    • Optimizing Team Capacity
    • Strengthening Governance & Leadership

    Demonstrating & Assuring Value

    1. Advancing Manageable, Meaningful Measurement – The Ministry’s recent announcement to review interprofessional primary care models puts new emphasis on providing solid evidence of the value of FHTS/NPLCs and team-based care. The Deputy’s consistent messaging regarding the need to improve performance measurement / management in primary care will also be a strong influencing factor in the development of new MOHLTC-FHT contracts. Physician participation is critical to making the case that the investment in team based care pays off by, among other things, optimizing total health system costs. PLC members spoke about the need to broaden the reach of physician involvement in manageable, meaningful measurement and the need to champion the work of D2D as the vital platform to demonstrate FHT value and drive quality improvement efforts. PLC encourages physician leaders to consider participating in D2D 2.0 and to stay informed – sign up for the bi-weekly D2D ebulletin.
    2. Choosing Wisely Canada (CWC) – CWC is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. PLC members endorse the concept of system stewardship / appropriate use of resources and encourage MDs and NPs to learn more about the Choosing Wisely Initiative. There are a number of early adopter health care organizations across Ontario that are beginning to implement CWC recommendations; HQO, OCFP and CFPC are also all actively involved. AFHTO will conduct further outreach to determine the value and applicability of the CWC initiative for our members and depending on what is found, consider measures related to Choosing Wisely recommendations for future iterations of D2D.

    Optimizing Team Capacity

    Deputy Minister Dr. Bob Bell has publicly stated that all Ontarians who would benefit from team-based care should have access to teams. Associate Deputy Minister Susan Fitzpatrick announced the review of interprofessional primary care models will include review of the use of interprofessional teams and the “opportunity to leverage these resources”. The recent FHT Evaluation report points to opportunities to improve team functioning and capacity. There are many facets to addressing this issue – including:

    1. Physician participation in teams – PLC members discussed ways that physician participation in primary care teams could be broadened and the potential issue of allowing physicians from outside of teams to refer to interprofessional health providers inside teams. PLC reps agreed to form a smaller working group to focus on approaches to maximizing resources/capacity to improve access to team based care and to identify potential risks, mitigation strategies and funding implications.
    2. Physician entry restrictions – There is understandable concern about the ministry’s new policy regarding managed entry into FHO and FHN models. The policy allows for replacement of positions vacated by an existing member of that FHO or FHN, outside of the “managed entry” process; however this is on a one-to-one basis – it does not allow for two physicians to divide the roster. AFHTO will continue to assist members and advocate for resolution of problems. PLC members also agreed it would be prudent for FHTs to work with their LHIN in identifying potential pockets of underserviced areas in their geographical region if they want to position themselves to meet the criteria of “high need”.
    3.  Improving team capacity through greater harmonization of FHT and FHO/FHN – PLC members briefly discussed the need and possible approaches to harmonize working relationships and practices for effective and efficient teamwork. AFHTO will look at developing a better understanding of the approaches FHTs are taking and at establishing a repository of tools, resources and/or frameworks that have been developed to support FHT-FHO/FHN relations and to drive the development of high performing teams.

    Strengthening Governance & Leadership

    There is a clear need to ensure that team-based primary care is rich with strong leaders and champions to lead the way for the sector as the ministry and stakeholders work to transform the health system. Given the Ministry’s upcoming review of primary care team-based models, the Ministry-FHT contract renewal, and the new requirements for FHTs/NPLCs outlined in the Governance and Compliance Attestation – this is a timely opportunity for FHT leaders to reflect on their own internal governance and leadership practices and for AFHTO to determine from a provincial perspective, opportunities to support ongoing governance and leadership development. PLC will continue to look at ways to support knowledge translation, improve collaborations/communications and strengthen physician leadership at the local level, including the development of FHT physician networks. The next meeting of the Physician Leadership Council will be held in late May / early June. Click here for the list of members. For further information, please contact:

    Sean Blaine, MD, Chair, Physician Leadership CouncilLead Physician, STAR FHTblaines@sympatico.ca Bryn Hamilton, MHSc, CHE, Provincial Lead, Governance & Leadership Program647-234-8601Bryn.Hamilton@afhto.ca

             

  • Data to Decisions eBulletin #7 – March 19, 2015

    Contributing to D2D 2.0

    Deadlines to collect data and submit information have been set: In response to feedback from members burdened with year-end pressures, deadlines have been set for the end of April. Next steps should be started now with your team:

    1. Sign up to contribute data to D2D 2.0 and create a codename to retrieve data from the report once it’s live.
    2. Schedule meetings with your Board and/or physicians to get the necessary permissions to request ICES data by April 21, 2015.  You will receive ICES data by May 17th. Note: A signed version of the form is required.  Please scan and email to AFHTO or fax to 416 920 6556 attention Denise Pinto.
    3. Deadline to submit data from all sources via D2D 2.0 submission platform is May 28, 2015.

    Additional details and the timeline for D2D 2.0 implementation are available here. D2D 2.0 indicators: Following input from members and the Indicators Working Group the list of indicators and data elements are now available online. The Diabetes and FTE measure indicators are being deferred to later iterations of D2D. See the data dictionary for more details on the indicators included in D2D 2.0. D2D video coming soon to a screen near you: Production is underway to produce a short 2-3 minute video explaining what D2D is and how it can benefit your team.  Teams can use it with staff, physicians, boards and other stakeholders to inform discussions about contributing to D2D 2.0.  Contact Carol Mulder for more information. Patients Canada and AFHTO launch the patient-doctor partnership survey:  Finishing touches are being put on a survey that will go out over Patients Canada’s network of patients later in March.  The survey will find out what’s most important to patients in their relationship with their family doctor. The results will be used in the upcoming D2D 2.0 report to create a “roll-up” indicator of quality that reflects the strength of the patient-doctor partnership.  This is a big step forward in patient-centered performance measurement.  Contact Puja Ahluwalia for more details.

    Using D2D 1.0 to improve data quality and care

    Hire a student to clean data in your EMR: The toolkit to assist members in hiring a student now includes detail on recruiting a student including relevant placement programs, sample job description and sample interview questions. Get started on a COPD registry: Teams interested in generating a list of patients with COPD can get started with a standardized EMR query built by the QIDSS.  The query is currently available for Telus PS and Accuro EMRs.  It isn’t perfect — about 15% of the patients found might not actually have COPD.  However, teams might find it is easier to start with this rather than try to come up with a list from scratch.  Click here for more detailed instructions on how to use the standardized query to get started with building a COPD registry with your team.  Volunteer to be part of the Patient Contact System – Pilot Project:  We are nearly at the 50-team mark for volunteers to pilot this exciting new way to connect with patients! If you were not able to participate in the demos this week (possibly because the webinars filled up quickly), see the recording of the demo or slide deck from the demo. For more information and eligibility requirements please check out the FAQ section and contact Marg Leyland if you’d like to sign up. Get easier access to your cancer screening reports: One of the outcomes of the regional sessions Cancer Care Ontario (CCO) has been hosting with QIDSS are tips to make it easier to access cancer screening activity reports (SAR).  As a first step, QIDSS are working to streamline the permissions process (e.g. OneID and delegate status) to help doctors more easily get current cancer screening data.  Contact your QIDSS or Carol Mulder for more information.  The regional sessions continue in Thunder Bay in May.

    Other news

    Tips from HQO for submitting your QIP in the Navigator: Quality Improvement Plans (QIPs) are due by April 1, 2015. HQO has provided the following tips:

    • At any time, you can test the submission of your QIP in order to see if any information is missing. In order to test the submission of your QIP, click the SUBMIT button – this will generate a detailed list of omissions that you can print. If you get to the sign-off window, it’s a sign that you are able to submit your QIP successfully (if you are not ready to submit, you can simply close the sign-off window).
    • There is no need to send a signed copy of the QIP to HQO. During the submission process you will be asked to include the names of those accountable on the QIP (this is considered sign-off approval). After submission you can export all three components of the QIP, format as desired, print, sign and post.

    What do you think? We hope you find value in the D2D eBulletin and will continue to subscribe to this newsletter. Other members of your team can sign up by clicking here. Once they complete the sign-up form a confirmation e-mail will be sent within 24 hours. In the meantime, if you have any comments or questions about the eBulletin, please let us know by e-mail to improve@afhto.ca. What is D2D? Data to Decisions (D2D) is a member-wide summary of performance on indicators that are both possible for members to measure and that are meaningful to members. See the D2D page on AFHTO’s website for more information.

  • Governance for Quality workshop: CME accreditation confirmed & Room discounts extended

    Don’t forget to register! 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. This FREE full day workshop is intended for board members, executive directors and lead clinicians of AFHTO member organizations. Click below to register and confirm your hotel before it’s too late:

           a. Book a hotel room, or contact the Reservation’s Centre: 1-888-627-7092.  Guest room booking                 deadline extended to March 18, 2015.

            a. Book a hotel room. Guest room registration deadline extended to March 20, 2015.

    Primary care boards and leaders must have the means to track performance, quality of care and value delivered, take action when needed, and meet the expectations of those to whom the organization is accountable. Take the time now to attend this governance education opportunity available free for you as an AFHTO member. Reminder: Material and recordings from our popular “Governance Webinars” series are posted online. All three webinars have been posted along with slide decks and Q&As.

  • Volunteers wanted for free pilot of a patient contact management system

    Is your FHT or NPLC interested in trying out – at no charge – a system to automatically call or email your patients? Up to 50 AFHTO-member teams can participate in a pilot to test this approach.  The system will allow teams to contact patients in whichever way they want for whatever reason they want. These reasons could include invitations to programs, to complete patient experience surveys, to remind patients of appointments or after-hours services, to request their email addresses, or even to wish them happy birthday! The goal of this project is to make it easier for teams to administer ongoing, consistent, patient experience surveys and otherwise engage patients in their care in meaningful ways.  This has been a long-standing priority for AFHTO members and is emerging as an increasingly important focus for the MOHLTC. AFHTO members formed a selection committee to find a vendor for this pilot. Thanks to ministry project funding, AFHTO is covering all of the vendor’s costs for the pilot sites to:

    • Integrate and implement the system with their EMR.
    • Deliver up to 500 patient contacts per team in the next year.

    Participating teams must be prepared to:

    • Spend approximately 1 full day (over several sessions) to implement the system.
    • Provide feedback for an evaluation of the system so that we can all learn from this pilot.
    • At the end of the year (or after 500 contacts, whichever comes first) choose whether or not they wish to contract with the vendor to continue this service.

    Participation is determined on a first-come first-served basis. Please see the Frequently Asked Questions for more information and eligibility requirements (log-in to members only required). Please contact Marg Leyland as soon as possible if you are interested.

  • Primary care recommendations in Home and Community Care Report

    Today the Ontario government announced “Ontario Endorses Expert Report on Home and Community Care” as it released Bringing Care Home, a report from the expert group on home and community care led by Dr. Gail Donner. The release stated, “This report will help inform the next steps in Ontario’s home care strategy which will be announced in the coming months.” The report presents what the expert group heard from stakeholders, and the experts’ response to what they heard – leading to 16 recommendations plus enablers required for their implementation. Key points for AFHTO members are the report’s calls for:

    • Clear, consistent definition of the “basket of services” and eligibility to receive them
    • Improved communication between home and community and primary care
    • Role of LHINs in both home and community care and primary care
    • Performance measurement, management and results-based funding, for both home and community care and primary care
    • Human resource planning, including strategies to address the wage gap between sectors

    These themes appear to be aligned with points recently reported from ministry meetings in recent emails to AFHTO members –  MOHLTC’s priorities and plans for primary care and What’s ahead for FHTs + NPLCs . AFHTO members will be pleased to see the report acknowledges the key role of primary care. Some excerpts:

    • The delivery of primary care should be better aligned with home and community care. Communication between primary care providers and service providers is poor (e.g., discharge summaries not sent or sent too late to be useful, communication between physicians and care coordinators is poor). Primary care providers are not always consulted in the development of home and community care plans, nor are they provided with provider assessments, care plans and reports.
    • One of the greatest opportunities to improve home and community care is to improve primary care so it is better equipped to serve its required role as a strong foundation for the rest of the health system.
    • Having an involved primary care provider is critical to the success of any home care plan.

    HIGHLIGHTS FROM REPORT RECOMMENDATIONS

    Clear, consistent definition of the “basket of services” and eligibility

    Recommendation 3 calls for the ministry to explicitly define which home care and community services are eligible for provincial funding, under what circumstances, determined using a common standardized assessment tool. Not only will this help patients and families, primary care providers would benefit from clear, consistent understanding of available support.

    Improved communication between home and community and primary care

    Recommendation 1 calls for a Home and Community Care Charter (found on p.18 of report) to be endorsed by the ministry and the principles incorporated into the development of all relevant policies, regulations funding and accountability strategies for this sector. The 11 statements in the charter include: 2.  A single care coordinator will work with the client and family to identify their needs and the most appropriate services to meet those needs. 3. The care coordinator and primary care providers will communicate regularly and in a timely fashion. Where appropriate, technology will be used to facilitate timely and ongoing communication among members of the circle of care.

    Role of LHINs in both home and community care and primary care

    The report points to a number of current challenges. Some excerpts:

    • Home and community care is funded through the LHINs, whereas most primary care practitioners are funded directly by the MOHLTC. Many of the strategies and services needed for more integrated care may already be part of the service agreements between primary care providers and the MOHLTC, and integration could be improved by assigning responsibility for managing those agreements to the LHINs.
    • Primary care was not explicitly in the Expert Group’s mandate; however, the engagement of primary care is a critical success factor for home and community care reform and many stakeholders, both families and providers, identified it as an issue of concern. Unless primary care and home and community care are well aligned, the needed transformation will not be possible. A critical enabler for this alignment is to manage the delivery of primary care through the same entity that manages other elements of home and community care: the LHINs.

    Recommendations 8 and 9 (see next section below) call for a direct role for LHINs with primary care.  To the extent that FHTs and NPLCs could be interested in becoming “lead agencies”, recommendation 11 is also of interest. Recommendation 8: That Local Health Integration Networks, in collaboration with the LHINs’ Primary Care Leads, develop and implement strategies to improve two-way communication between primary care providers and home and community care providers. Recommendation 11: That the Ministry of Health and Long-Term Care direct the Local Health Integration Networks to select and fund the most appropriate lead agency or agencies to design and coordinate the delivery of outcomes-based home and community care for populations requiring home and community care for a long term within their LHIN. (See p.28 of report for minimum requirements for the lead agency.)

    Performance measurement, management and results-based funding

    The report identifies several prerequisites for the successful implementation of its recommendations. One of these states, “Until all primary care providers are held accountable for the terms of their services agreement, primary care will not be fully and successfully aligned with home and community care.” Recommendation 9 states that, where performance agreements with primary care providers exist (e.g. with Family Health Teams and Community Health Centres), the Local Health Integration Networks take responsibility for managing performance against the service standards in these agreements and making these results publicly available. Following this recommendation, the report goes on to state:

    Although many family health teams have service agreements with the MOHLTC, most of the performance standards are currently related primarily to volume of services. The Primary Care Performance Measurement Steering Committee at Health Quality Ontario is working on system-level indicators and practice-level indicators that will be publicly reported. These indicators should be incorporated into all relevant performance agreements. The Committee’s work will enhance the LHINs’ ability to monitor performance of some primary care providers in their region.
     

    AFHTO’s work with members on the QIDS program and Data to Decisions (D2D) initiative, is giving leadership to advance primary care measurement in a manageable and meaningful way. Recommendation 15 goes further to propose that the Ministry of Health and Long-Term Care tie funding for home and community care services (e.g. home care, community support services, primary care) to the achievement of clearly defined outcomes and results.

    Human resource planning and wage gaps between sectors

    AFHTO and its collaborators have been strongly promoting solutions to the problems in recruitment and retention in primary care. We are pleased to see the Expert Group also identified this among the prerequisites for the successful implementation: A human resource plan is needed to address shortages of health human resources. Such a plan should address the lack of care providers in rural and remote communities and include strategies for closing the gap in wages across the province and between sectors and working towards sustainable full-time employment for workers in this sector. As more and more primary care providers do home visits, the following prerequisite is also welcome:

    • Every worker is entitled to a safe environment. When the work place is the client’s home, it is more difficult to ensure a safe environment for both the client and the care provider. Strategies and policies are needed to provide a safe workplace for home and community care providers.

    Implementing the recommendations

    The final recommendation calls for the Ministry of Health and Long-Term Care appoint Home and Community Care Implementation Co-Leads (one Co-Lead from within and one from outside of the Ministry), with appropriate support, to guide and monitor the implementation of the recommendations in this report, reporting annually to the Minister of Health and Long-Term Care.

  • Governance training: Webinars now online // Register NOW for in-person workshop (hotel group rates expire in 3 days)

    It’s time to take advantage of governance education opportunities available just for you as an AFHTO member. These materials support primary care leaders with your capacity to guide your organization and impact the direction of our health system’s transformation. Register now for FREE workshops on March 25th and March 30th: Effective Governance for Quality in Primary Care Full day workshop is intended for AFHTO member board members, executive directors and lead clinicians. Hotel group rates expire Friday, March 13, 2015 so please confirm your registration as soon as possible.

    Material and recordings of recent “Governance Webinars” series now posted online You can now view our popular “Governance Webinars” for primary care leaders. All three webinars have been posted along with slide decks and Q&A:

    1. Session 1 (Feb 18 & 20): Getting Started
    2. Session 2 (Feb 23 & 27): The Board’s Responsibilities
    3. Session 3 (Mar 2 or 4): Looking Forward – using good governance to enhance organizational performance

    Please click on the links for further information on the workshops and webinars.

  • What’s ahead for FHTs + NPLCs: update from Mar. 5 PHC Branch meeting

    Topics discussed at AFHTO’s March 5, 2015 quarterly meeting with PHC Branch are listed below. Key points made by Deputy Minister in a March 9 speech are added.  Scroll down for details on each.

    1. What’s ahead for FHTs + NPLCs, in light of ministry’s plans for health system reform?
      1. “Comprehensive regionally governed, population-based primary health services for Ontarians.”
      2. Process for determining “high needs” areas / replacement of FHO+FHN physicians
      3. Review of primary care team models
      4. Development of new contract templates for FHTs
    2. More immediately, what can FHTs and NPLCs expect from this year’s operating plan and funding process?
      1. Outlook for funding approvals
      2. Data support for FHTs and NPLCs
      3. Premises costs
      4. Performance measures in the 2015-16 Service Plan (“Schedule A” or “Part B)
      5. Governance and Compliance Attestation
      6. Accountability Reform Initiative
      7. Reallocation and some inconsistency in decisions
      8. Telemedicine equipment
      9. Getting meaningful feedback from your consultant

    1. What’s ahead for FHTs + NPLCs?

    AFHTO members received an email summarizing Associate Deputy Minister Susan Fitzpatrick’s meeting with the AFHTO board on March 3.  AFHTO’s representatives met with PHC Branch on   March 5 to learn more about what’s ahead for primary care in Ontario and advocate for our members. On March 9 Deputy Minister Bob Bell delivered a speech which added further specificity to ministry priorities.

    “Comprehensive regionally governed, population-based primary health services for Ontarians.”

    This statement has appeared on slides used by both the Deputy and the Associate Deputy Ministers – the intent is clear, but not much more is known at this time.  In his March 9 speech, the Deputy emphasized the critical need for a strong foundation of primary care, and went further to speak of a “possible move to Accountable Care Organizations as our primary care system strengthens.”

    Process for determining “high needs” areas / replacement of FHO+FHN physicians

    This topic is clearly linked to the statement above.  The ministry has communicated changes to primary health care physician payments, such that, “effective June 1, 2015 and onwards, monthly registration into these models will be limited to 20 physicians per month in areas of high need.” By end of March, the ministry is aiming to have the criteria and process in place for determining “areas of high need”. LHINs will be playing a key role. The ministry’s new policy regarding entry into FHO and FHN models does allow for replacement of positions vacated by an existing member of that FHO or FHN, outside of the “managed entry” process. The PHC Branch reps confirmed this is on a one-to-one basis – it does not allow for two physicians to divide the roster. Key points for FHTs and NPLCs:

    • Future relationship between LHINs and primary care: Much is not yet known, but this clearly signals much greater involvement with LHINs going forward. This is already happening with Health Links. Many AFHTO members have already developed good relationships with their LHINs; it would be prudent to strengthen these, and keep the leadership in your LHIN aware of the needs and opportunities in your community.
    • FHT and NPLC leadership: AFHTO members have already developed the capacity to lead, govern and build strong collaborations with other partners. Of the 69 Health Links to date, 20 are led by AFHTO members. You are well-positioned to play important leadership roles within your region and more broadly across the province, to shape what “Comprehensive regionally governed, population-based primary health services” will look like.

    Review of primary care team models

    AFHTO’s March 3 email also reported the ministry will be reviewing the team-based models from the perspectives of performance and accountability, funding, and use of interprofessional teams (recruitment and retention, ratios of team members, opportunity to leverage these resources). The ministry is developing terms of reference for this review, and is considering the range of team-based models to be included. One of the ministry’s drivers is to ensure that Ontarians who could benefit most from team-based care have access to this. The review is still in early development but the PHC Branch confirmed that AFHTO and related associations will be involved to inform the review process. Key points for FHTs and NPLCs

    • “Programs” and “comprehensive team-based primary care”: AFHTO has been challenging PHC Branch to look beyond their focus on “programs” if the ministry is truly interested in reaping the full value of comprehensive team-based primary care. PHC Branch has acknowledged this need – see below regarding “Schedule A” of the FHT annual operating plans.
    • Value comes from team collaboration, not referral: AFHTO has been taking every opportunity, including this meeting, to stress this point. The pressure to broaden access to teams has led some in the ministry and elsewhere to look to enabling physicians outside of teams to refer patients to IHPs within teams. Research evidence to date in Ontario, including the FHT evaluation report, points to the value of team collaboration, with all providers, including family physicians, as active members of that team.  The question is how to strengthen teams and broaden their reach.
    • What does it mean to be a team? Following from this, we will all be thinking about the further evolution of these team-based models and how the various providers are connected to them.
    • Measuring the value of team-based care: AFHTO continually reminds the ministry that the cost of team-based care is NOT the question – it is the value delivered for system sustainability. Data to Decisions (D2D) 2.0 will include further refinements to the measure of “total cost of care”. Your participation is critical to making the case that the investment in team-based care pays off by, among other things, optimizing total health system costs for patients. Stay informed – sign up for the bi-weekly D2D ebulletin.

    Development of new contract templates for FHTs  

    Contracts between MOHLTC and FHTs expire on March 31, 2016. AFHTO is ready with clear direction from the leaders of our member-organizations on the necessary principles – for the governance of primary care organizations; for accountability and reporting to funders; for determining accountability measures; for funding allocation; and for the support teams need to deliver timely, high-quality, comprehensive team-based care. In his March 9 speech the Deputy emphasized several times over the need to improve performance measurement and performance management in primary and community care, as has been done in hospitals. No doubt this will be reflected in future contracts. AFHTO and PHC Branch will meet again in a few weeks for further discussion of the specific question of measurement and reporting. Key points for FHTs and NPLCs

    • AFHTO continues to work with and on behalf of members to advance manageable and meaningful measurement. Through the Quality Improvement Decision Support program AFHTO members are strengthening capacity to measure and leading the way to identify appropriate and meaningful measures.
    • Likewise, AFHTO members are guiding development of contract templates. The ED and Physician Leadership Councils will play key roles in advising the AFHTO board as these discussions move forward.

    2. What to expect in 2015/16 operating plan and funding process

    AFHTO probed into a number of issues and questions members have been asking. Following from this meeting with PHC Branch, we offer the following advice to members;

    Outlook for funding approvals

    In simple words – don’t expect new money. Government has not yet presented its 2015/16 Budget, so the size of the “pies” to be divided among FHTs and among NPLCs is not yet known. These “pies” have been fully stretched in the past year, and as is happening in the rest of government, they could shrink. FHTs/NPLCs that are seeking additional funds can expect the approval process will take at least 4 months. Those who are only requesting reallocations of their base funding can expect fairly quick turnarounds.

    Data support for FHTs and NPLCs

    All AFHTO members – NPLCs and FHTs — are welcome to take full advantage of AFHTO’s QIDS Provincial Program. Unfortunately about 25 FHTs and all 25 NPLCs have no access to direct support from a QIDSS Specialist. The ministry is considering a proposal from NPAO for the NPLCs, and will consider any others from FHTs, however the funding situation described above means additional positions may not be possible.

    Premises costs

    Following the same theme as above – the ministry will consider increases where premise costs have gone up, but will insist that you first look at funding from within your existing budget.

    Performance measures in the 2015-16 Service Plan (“Schedule A” or “Part B)

    The Annual Operating Plan for FHTs includes “Schedule A – FHT Service Plan”.  NPLCs report their Service Plan in “Part B: 2015-2016 Strategic Priorities and Vision”, which includes strategic priorities, program and service commitments. The “Schedule A Guidance Document” in the FHT AOP package also gives specific instructions to list each of the FHTs programs, target population, objectives and performance measures. Key points for FHTs and NPLCs:

    • Following from the “programs” versus “comprehensive team-based primary care” discussion above, the ministry welcomes seeing “comprehensive team-based primary care” listed as a program, with objectives and measures.
    • The examples in the FHT Guidance Document are “counts” rather than actual performance measures with numerators and denominators. PHC Branch confirmed performance measures are welcome. The need is to demonstrate the return on the public investment.
    • For FHTs, the three topics at the top of the Schedule A submission sheet are required – enrollment, same day/next day and house calls.
    • For all other measures your FHT or NPLC can choose what you believe is most appropriate for your organization.

    Governance and Compliance Attestation

    All FHTs and NPLCs must submit the Governance and Compliance Attestation. This form sets out the ministry’s expectations for appropriate governance practices. If a FHT or NPLC is lacking in any areas, the PHC Branch has said they will work with the entity to improve in these areas. It will also send the aggregate results to AFHTO to share with the membership and focus our Governance and Leadership programming. A number of EDs asked about the requirement that “FHT has a current Performance Measures document monitored by the Board on an ongoing basis”. In the Attestation the ministry is looking for a simple “yes/no” response, although the PHC Branch will do occasional audits. The Quality and Safety section of AFHTO’s Fundamentals of Governance guidebook and toolkit provides guidance for boards on their fiduciary duties for performance and how performance measures are used to fulfill this duty. Suggestions include using AFHTO’s Data to Decisions 1.0  measures. (For more information about the upcoming D2D 2.0 indicators, click here.)

    Accountability Reform Initiative (ARI)

    Once again FHTs have the option to apply for ARI, which would give the team greater flexibility in how it uses its budget. It will be granted to those who meet all the governance and compliance requirements. Those who come close but don’t quite make it can be reconsidered later in the year if they’ve taken all the necessary steps to comply. NPLCs may be able to apply for ARI in the 2016-17 Annual Operating Plan process. Since they are newer entities, the ministry is waiting another year before potentially extending ARI to them.

    Reallocation and some inconsistency in decisions

    Following from the ministry’s recent call for reallocation requests, member EDs had reported to AFHTO some situations where consultants had not allowed a budget reallocation. The common element in the issues in question appeared to be regarding what physicians should cover.  PHC Branch reported they received over 100 submissions and are working to improve the response process. There are budget guidelines regarding what should be covered by the physician group, and decisions can be reviewed to ensure they’re applied consistently.

    Telemedicine equipment

    Members have been faced with vendors declaring ‘end of service’ for their telemedicine equipment and financial challenges to replace equipment. Some have been able to find funds within their budgets to address this; others have made arrangements through their local hospitals.  AFHTO members have offered assistance to help the ministry develop a more sustainable and unified strategy for ongoing OTN support. Recognizing this issue involves OTN, its funder (eHealth Ontario), the Northern Health Travel Grant program and the Nursing Secretariat, PHC Branch has agreed to take the first step. Starting with FHTs and NPLCs in the NE/NW, they will look at the most valuable uses of OTN equipment, how much of OTN use falls into this category, and whether a sustainability policy can be developed.

    Getting meaningful feedback from your consultant

    The short answer is – phone your consultant. AFHTO members periodically send us examples of feedback letters from ministry that offers no insight into why a decision was made. FHTs and NPLCs want to improve – and need specific, constructive feedback to help them do so. PHC Branch reported that each letter must be reviewed and approved before going out, so content is limited.

    3.    Participants in the March 5, 2015 meeting

    AFHTO was represented by:

    • Randy Belair (AFHTO President and ED, Sunset Country FHT, Kenora)
    • Ross Kirkconnell (Secretary + QIDS Steering Committee Chair and ED, Guelph FHT)
    • Kavita Mehta (ED Advisory Council Chair and ED, South East Toronto FHT)
    • Angie Heydon (AFHTO Executive Director)
    • Carol Mulder ( AFHTO QIDS Provincial Lead)

    MOHLTC’s PHC Branch representatives were:

    • Phil Graham (Acting Director, PHC Branch and Manager, Interprofessional Programs Unit)
    • Fernando Tavares (Program Manager, Interprofessional Programs)
    • Alexa Pagel (Senior Program Consultant)

  • Data to Decisions eBulletin #6 – March 5, 2015

    Contributing to D2D 2.0 

    Indicator selection: The indicators for D2D 2.0 have been approved by the AFHTO Board. Please review to decide which indicators your team could and would submit to the report. You may want schedule meetings with your clinical lead(s) and/or Board of Directors to review the data and approve it for submission. The deadlines for data submission are projected for early April – dates will be confirmed shortly. Data submission tool: For D2D 2.0 teams will enter their data directly into a tool that is now being developed (instead of sending in an excel file). Teams participating in D2D 2.0 will be asked to designate one individual from their team with authority to submit data. Several QIDSS will be testing the tool for usability starting on March 19th. Contact Puja Ahluwalia or Greg Mitchell for more information.

    Using D2D 1.0 to improve data quality and care

    Hire a student to improve data quality in your EMR: The toolkit to assist members in hiring a student has been posted on the members-only website. The toolkit was developed with input from members that have successfully engaged students to improve data quality in their EMRs. If you are considering getting a student, particularly if it is for this summer, it is important to start the process now. See the toolkit for next steps. Build a COPD registry in Telus PSS and Accuro EMRs: A query will soon be available from the QIDSS to generate a list of COPD patients. The QIDSS have developed the query in collaboration with CPCSSN, EMRALD and the ALIVE project. It is not perfect – about 15% of the patients found might not actually have COPD – but this may be an easier way to start finding these patients than starting from scratch. The query and instructions will be released in the next eBulletin. In the meantime, contact Greg Mitchell for more information. Pilot project for a patient contact system (for patient experience surveys etc): Proposals are under review for a vendor to develop and implement a service to automate the process of contacting patients.We will be looking for 10 teams to pilot the service by March 31, 2015. If your team is interested in participating, please contact  Marg Leyland. A more detailed call for volunteers will be issued shortly. In the meantime, please see the Request For Quotes for more details. QIDSS attended learning sessions to improve quality of clinical data in EMRs: Cancer Care Ontario (CCO) hosted the third of five regional sessions this week with QIDSS and the CCO Regional Primary Care Leads in Sudbury. Among topics discussed were: strategies to make it easier for QIDSS to support physicians in accessing their SARs; the extent of similarity between EMR and SAR cancer screening rates; and information and resources available to QIDSS and AFHTO members from CCO’s Primary Care Leads. There are upcoming sessions scheduled for QIDSS in Toronto and Thunder Bay.

    Other news about manageable meaningful measurement

    Thanks for completing the EMR migration survey: Responses were received from about one quarter of AFHTO members and are now being compiled. Further details will be available over the next month. In the meantime, contact Marg Leyland for more information.

    What do you think?

    We hope you find value in the D2D eBulletin and will continue to subscribe to this newsletter. Other members of your team can sign up by clicking here. Once they complete the sign-up form a confirmation e-mail will be sent within 24 hours. In the meantime, if you have any comments or questions about the eBulletin, please let us know by e-mail to improve@afhto.ca. What is D2D? Data to Decisions (D2D) is a member-wide summary of performance on indicators that are both possible for members to measure and that are meaningful to members. See the D2D page on AFHTO’s web site for more information.

  • MOHLTC’s priorities and plans for primary care

    This message presents what the Deputy and Associate Deputy Ministers of Health and Long-Term Care said recently about the ministry’s key priorities for health system transformation, the role of primary care in this transformation, and some of the key steps ahead. While the media have asked if government “has pressed the pause button on team-based primary care” (Globe and Mail, TVOntario), the information below indicates significant movement ahead. The content of this email comes from Associate Deputy Minister Susan Fitzpatrick’s meeting with the AFHTO board on Feb. 25 (click here to access her slide presentation). Many of the same points were reiterated the next day in addresses made by Deputy Minister Bob Bell and by Susan Fitzpatrick at the Feb. 26 HealthLinks conference. Highlights:

    • “Primary care must be the strong foundation for our health system.” Both DM Bob Bell and Associate DM Susan Fitzpatrick clearly stated this view. The key question – what does this look like and how will we get there?
    • “Comprehensive regionally governed, population-based primary health services for Ontarians.” Slide 10 is a specific look at how the ministry sees primary care teams in advancing transformation, from 2005 and into the future. On several occasions the Deputy has called for movement toward “population-based risk-adjusted primary care”; this slide confirms the intent.
    • Ministry’s key priorities for primary care teams. Slide 12 lists them as follows:
      • Population health based programs and services with focus on access, integration and patient experience
      • Collect community-specific data to improve performance and quality of primary care for its population
      • Continue progress in expanding availability of same day/next day appointments and after-hours
      • Continue to provide access to integrated health care teams for Ontarians who need it
      • Establish policies to improve Quality Improvement indicators ( e.g. post-hospital discharge visits, readmission rates, ED visits)
      • Participation in HealthLinks and other local initiatives (e.g. Physiotherapy reform)
      • Leveraging full scope of practice and improving team functioning
      • Strengthening and expanding local partnerships and care coordination
    • “Sector Leadership and Excellence are Critical.” Slide 6 depicts the adoption curve; AFHTO members are clearly identified in the “Early Adopter” group. Our individual and collective work to engage patients, advance measurement, spread best practice and improve quality is recognized by the ministry, and in the results of the recent Conference Board of Canada FHT evaluation report. Team-based primary care is rich with strong leaders and champions to lead the way for this sector as the ministry and stakeholders work to transform the health system.
    • Review of interprofessional primary care models. On both occasions Susan Fitzpatrick stated it was time to review the team-based models from the perspectives of performance and accountability, funding, and use of interprofessional teams (recruitment and retention, ratios of team members, opportunity to leverage these resources). FHTs and CHCs will be included in the review. The ministry is developing terms of reference for this review, and is considering the range of team-based models to be included.

    AFHTO continues to work with and on behalf of members to show the way forward. We are ready with clear direction from the leaders of our member-organizations on the necessary principles – for the governance of primary care organizations; for accountability and reporting to funders; for determining accountability measures; for funding allocation; and for the support teams need to deliver timely, high-quality, comprehensive team-based care. Collectively we continue to advance measurement capacity to give solid evidence of the value of team-based care, and develop governance and leadership capacity to lead the way. We will ensure our members’ successes are seen and voices heard by the ministry and stakeholders. We look forward to showcasing and further invigorating this work at the AFHTO 2015 Conference in October — Team-Based Primary Care: The Foundation of a Sustainable Health System.