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Tag: Reports

  • Connecting People to Home and Community Care Act, 2020 (Bill 175) – AFHTO’s Submission

    On June 17, AFHTO presented its submission to the Standing Committee on the Legislative Assembly on Bill 175: Connecting People to Home and Community Care Act, 2020. Our key recommendations are:

    1. Delay the passage of Bill 175, Connecting People to Home and Community Care Act, 2020– Delay the passage of Bill 175, Connecting People to Home and Community Care Act, 2020 until the findings of the LTC commission and investigation are completed and the challenges to the pandemic response are detailed, including how care was or was not provided in people’s homes or in the community.
    2. Embed care coordination in primary care– We recommend the relationship between primary care and home and community care be strengthened by transitioning the function and associated resources of care coordination to primary care. This will bring greater efficiency and patient-centredness to care. Care will be integrated, allowing for seamless transitions of care for patients. It will reduce duplication and inefficiencies in the care coordination process and allow for more flexibility and integration in care planning. Patients will move through the system and providers with a single care plan, and outcomes will improve due to greater continuity and coordination of person-centred care.
    3. Supporting the patient’s journey through the health and social system with one patient record– The role of a care coordinator needs to be less administrative in nature and more systems related. What is critical is care coordination as a function and a role that will support the patient through the complex health and social systems. That individual needs to be a member of a team who works with the patient and the team as a system navigator for both health and social care, using the same electronic medical record to ensure one fulsome patient story.

    Read the full document here

     

    Input on proposed regulations 

    AFHTO and OCFP Response to Proposed Home and Community Care Regulations Related to the Connecting People to Home and Community Care Act

    AFHTO’s feedback on proposed Home and Community Care Regulations – July 2021

     

  • AFHTO’s Submission on Bill 74: The People’s Health Care Act, 2019

    On April 2 AFHTO presented its submission to the Standing Committee on Social Policy on Bill 74: The People’s Health Care Act, 2019. Our key recommendations are:

    1. That Bill 74 require primary care to be part of an Ontario Health Team (OHT). It is also recommended that primary care teams be the lead of an OHT in areas with highly functioning teams who can continue to be leaders in delivering truly integrated care. Primary care is the entry point to the health care system. These are the health care providers who know the patients and their families the best.

    2. That Bill 74 (Part IV – Definitions) be strengthened by including the vision of the Patient’s Medical Home when speaking about the Integrated Care Delivery Systems, with specific notation made to the Minister’s Patient and Family Advisory Council Patient Declaration of Values. While there is notation in the preamble about the importance of the patient in the development of Bill 74, it is important that there also be a strong vision for this health system restructuring, especially with the creation of the local level Ontario Health Teams. The Patient Medical Home encompasses that vision – it puts the patient and the family in the center of care while also recognizing the importance of the Quadruple Aim through its pillars.

    3. That there be an addition in Part IV of the Bill under Integrated Care Delivery Systems that specifically outlines governance of integration, including principles of collaborative governance and what the requirements will be of the Boards of the HSPs that are coming together to change the way care is being delivered in their community. For integrated health care systems, it is truly placing the patient at the center of care – not the organization where the care is being delivered. And that, for many, will require a tremendous amount of change management support. Health care organizations have been funded in siloes for decades with targets and indicators that are very specific to their funding. A move towards a shared budget will require a shift in thinking, new partnership building and, fundamentally, trust.

    4. a)  As Ontario Health starts becoming operational, we recommend it stay true to Part II (The Agency) Objects and General Powers and support the health service providers in the sector as outlined in the Bill and NOT be involved in direct service delivery, including in the area of home and community care.
    b)    We ask that the relationship between primary care and home and community care be strengthened by transitioning the function and associated resources of care coordination to primary care.
    c)    It should also be noted that in any application for an OHT, there should be concerted effort made to ensure that primary care and mental health and addictions supports are integrated and it is our recommendation that this is a priority for each integrated care delivery system in the province.

    AFHTO is pleased to see the government’s commitment towards truly integrated patient-centred care. Health care providers in interprofessional team-based primary care have been working in integrated systems of care for years but have felt that there is still fragmentation in the care they are able to provide, mainly because of the disconnect between the siloes of care, from acute to home care, from mental health and addictions to long-term care. Primary care is the entry point to the health system and for many patients in the province, the relationship they have with their family physician or nurse practitioner is everlasting and built on trust. A truly effective, high quality health care system needs to be coordinated, integrated and foundationally built in primary care, which will ensure we are delivering a sustainable health system for the future.

    Team-based primary care is popular with its 3.5 million patients because it provides a better patient experience, helping people avoid long and confusing waits for referrals and getting lost navigating our complex system. We need to expand this experience so that every Ontarian can get access to the care they need when they need it. We look forward to working with the government as it starts the journey on implementing this very important health restructuring plan and creating a new integrated system of care that is focused around the patient.

    Relevant Links:

  • The most effective outreach for patients overdue for cancer screening, according to St. Michael’s Hospital Academic FHT

    By Tara Kiran, MD, MSc, Sam Davie, MSc, Rahim Moineddin, PhD, and Aisha Lofters, MD, PhD; St. Michael’s Academic FHT

    Background: There is good evidence that cancer-specific patient outreach improves rates of cervical, breast, and colorectal cancer screening. However, it is unclear how primary care practices should implement integrated outreach for all 3 types of cancer screening. They aimed to understand whether integrated outreach using mailed letters or phone calls were more effective at increasing screening uptake in a primary care organization.

    Click here to access the complete article

  • Data to Decisions: Advancing Primary Care

    Data to Decisions: Advancing Primary Care is a membership-wide report on performance in primary care. It helps local teams see where they stack up against their peers on a small number of measures. QIDS Specialist Host & Partnership Forum: The September 1st, 2015 forum was attended by over 90 QIDS specialists and QIDS specialist host and partner Executive Directors.  The purpose was to celebrate our collective progress via analysis of D2D 1.0 vs. 2.0 data and preparing teams to move forward faster further. For more information check out the presentation slides or watch a recording of the webinar. Why participate in D2D? Click here for a video to help EDs, physicians, Boards and QIDSS start discussing D2D and how your team can participate. 

    Past Reports

    The submission/historical data forms for D2D 1.0 and D2D 2.0 are temporarily unavailable while we prepare for the launch of D2D 3.0 on December 3, 2015.

    The D2D journey continues – getting started on the next iteration of D2D

    Measures will continue to be refined to become more and more meaningful to providers and their patients, and acted upon to improve care. Calling all clinicians! Make sure D2D makes good clinical sense – join the conversations by July 24, 2015 to come up with better indicators for Emergency visits, 7-day follow up and other clinical measures.

    Stay up to date on D2D – The eBulletin is released bi-weekly to help members keep track of upcoming D2D deadlines and share updates and information about manageable meaningful measurement.

    Resources and Links

    For more information about D2D contact Carol Mulder, QIDS Provincial Lead, carol.mulder@afhto.ca.

  • EDAC meeting report: Shaping the future of MOHLTC contracts and the “Primary Care Guarantee”

    Yesterday’s meeting (Aug. 20) of AFHTO’s Executive Director Advisory Council (EDAC) included preliminary discussion to prepare AFHTO for advocacy on behalf of members on two key topics:

    • The contractual relationship between Ministry and primary care organizations
    • Shaping the Ontario government’s “Primary Care Guarantee”

     Towards the next Ministry contract Current contracts between MOHLTC and FHTs will expire on March 31, 2016. MOHLTC has signalled its intent to maintain consistency in contractual requirements across NPLCs, FHTs and other interprofessional models. Over the next year AFHTO members – through their association – have a critical, time-sensitive opportunity to shape their contractual relationship with their primary funder. Ideally, the MOHLTC contract would set up a framework that would allow for things such as:

    1. Accountability based on patient outcomes, access/quality of comprehensive primary care, and appropriate use of public funds.
    2. Funding that supports optimal use of resources to deliver quality care and patient outcomes.
    3. Measures to harmonize work where more than one organizational entity (e.g. FHT and physician group, FHT/NPLC and embedded CCAC or other staff) is involved, to optimize the performance of the clinical team

    EDAC members were asked for feedback on the process for engaging board chairs, MD/NP leads and EDs of AFHTO member organizations. The annual Leadership Session on October 15, immediately preceding the AFHTO annual conference, will be the first step in engaging members to define their collective vision and priorities for shaping this contractual relationship with the Ministry. Prior to the session, a survey accompanied by a concise backgrounder on the issues will be sent out to all board chairs, MD/NP leads and EDs. The purpose of the survey will be to both inform all of the leaders in our membership as well as to assess which issues are central to developing guiding principles. The survey will be piloted with a small group of volunteer EDs from EDAC in late August. The survey will be sent to all our members by September 17. Shaping the “Primary Care Guarantee” In the recent election campaign, the now-governing Liberals declared a “Primary Care Guarantee” – it “will ensure that every Ontarian has access to a primary care provider by 2018”. This document stated: To make the Guarantee a reality, Premier Kathleen Wynne’s Liberals will:

    • Focus on northern, rural, and fast-growing communities to improve availability and access to primary care, including the use of Community Health Centres and satellites.
    • Work with our physician partners to help them take on more patients, faster.
    • Improve the recruitment and retention of community-based primary care teams.

    On behalf of members, AFHTO’s priority issues have been recruitment and retention of primary care staff, expanding access to interprofessional teams, and support for measurement. These were the three key messages in AFHTO’s “Better Care. Healthier Families. Best Value” campaign before and during the provincial election. As a sector, we now have the opportunity to work with government to shape its direction for achieving the “Guarantee”, in line with what our members believe to be the priorities and needs for advancing the membership’s vision – that all Ontarians have access to high-quality, comprehensive primary care, that is informed by the social determinants of health, delivered by collaborative teams, anchored in an integrated, equitable and sustainable health system. EDAC was asked for input in the early development of advice for government. Discussion resulted in the following list of factors to explore:

    • Staffing:
      • Extent to which reduction in current vacancy and turnover rates could improve access to primary care
      • Opportunities to expand “grow your own” programs to address skills shortages in some communities
    • Opportunities to support and deploy teams as effectively as possible:
      • Need for appropriate IT infrastructure: deficiencies impact the capacity of health professionals to provide care and present challenges in a competitive recruiting environment.  Solutions to the barriers/limitations of current IT funding models may enhance capacity to care for more patients.
      • Opportunities within the team:  patient needs met by right professional at the right time, working to full scope of practice. Flexibility to shift skills mix as needs change
    • Need for community-based planning:
      • Planning to meet needs must be done at the local level
      • Interprofessional teams can (and do) play a key role in assessing and addressing community needs
      • Explore opportunities to improve access by expanding existing teams
    • Need for measurement that allows for capacity and quality to be tracked, to better inform on what’s working and where further support/investment is needed:
      • The Starfield Model, AFHTO’s approach to primary care measurement will by a key factor. It focuses on the relationship with patients and ability to deliver the care patients value. Its objective is to optimize quality, access and total health system cost of care for patients, using indicators from Health Quality Ontario’s Primary Care Performance Measurement Framework. The model and a case study of its implementation was just published in the Healthcare Management Forum – The Starfield model: Measuring comprehensive primary care for system benefit.

    AFHTO looks forward to working with members to continue to develop and refine our advocacy priorities and recommendations on these topics.

    • Members are welcome to send comments on these advocacy topics to AFHTO’s Executive Director – Angie.Heydon@afhto.ca.
    • Questions and comments regarding EDAC can be sent to AFHTO’s Provincial Lead for Governance and Leadership – Clarys.Tirel@afhto.ca.

  • Advancing a Performance-Oriented Model for Primary Care

    Advancing a Performance-Oriented Model for Primary Care One of AFHTO’s strategic directions is to build evidence of FHT performance and value to patient health is. Key to this is the capacity of FHTs to make the IT/IM investments needed to capture and report data consistently and reliably, and to use it for improvement.   Consistent with the direction of the Drummond Report, performance in quality outcomes, practice capacity, and health system costs must be tracked and improved. AFHTO recently submitted a proposal to the Premier’s Office for a pilot project to support primary care teams to do this, and to assess the resulting improvements. Click here to read the proposal summary.

  • Toward a Primary Care Recruitment & Retention Strategy for Ontario

    The Association of Family Health Teams (AFHTO), the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners’ Association of Ontario (NPAO) are pleased to share our joint report with our members.

    It has been a challenge for primary care organizations to recruit and retain the skilled and compassionate staff needed to deliver accessible, high quality, patient-centred primary care. Our three associations – representing all of Ontario’s interprofessional primary care organizations – teamed up in September to gather the facts and create the solid case to address the issues. About half of the 295 organizations – 10 aboriginal health access centres (AHACs), 73 community health centres (CHCs), 186 family health teams (FHTs) and 26 nurse practitioner led clinics (NPLCs) – responded to our survey.  This information, together with data from salary studies by the Hay Group, has been combined to make the compelling case. Our joint report was finalized this week and sent to the ADMs of Negotiations and Accountability Management Division and Health Human Resources Strategy Division in advance of our meeting on Feb.22.  The meeting had been scheduled for Feb.9 but was postponed due to personal circumstances. The report makes the case that:

    • The full compensation package – salaries, pensions and benefits –must be addressed to make working in primary care sufficiently attractive to recruit and retain competent staff in this sector.  Recognizing current economic constraints, it is well understood that reaching a competitive compensation level will need to be phased in over a few years.
    • As an immediate first step, the barrier to labour mobility must be removed to enable all primary care organizations to offer the HOOPP pension plan and reasonable benefit package.  This entails a 2.5% increase in compensation funding, for a total of $10.36M.
    • Since staff are required to contribute a minimum of 6.9% of gross earnings toward the pension, a matching increase of 2.5% should be added for all staff to defray their reduction in take-home earnings.  This would bring the total investment across all of primary care to $19.48M.

    The investigation found:

    • The biggest vacancy rates appear among the largest staff groups, e.g. 19% for Nurse Practitioners, 14% for dietitians, 10% for RNs, and 5-12% for administrative managers.  Add to this an 18% vacancy rate for pharmacists, and the result is a serious gap in skills to provide the full scope of primary care, particularly chronic disease prevention and management.
    • Factoring in turnover rates and the time needed to fill each type of position, roughly 6-7% of overall staff service capacity is lost each year due to turnover.
    • The most troubling finding is that the majority of staff who leave are then lost to the primary care sector – only 1/3 move to other primary care settings, but about 1/2 go to work in hospitals and other health care settings.
    • While Ontario’s Action Plan for Health Care calls for placing “Family Health Care at the Centre of the System,” there are barriers to attracting health providers to primary care and keeping them in this part of the health system.
    • There is overwhelming evidence that compensation packages are the root cause. Independent review found salaries to be 5 – 30% below market. Lack of the HOOPP plan makes it hard to compete with the other health sectors that do offer it.
    • Growing inequity in compensation is creating conditions for rapid expansion of unionization in this sector, beyond the 10% of PCOs who currently have staff under collective agreements.

    Please click here to read about the outcome of the joint meeting.