CEO Report January 2013 - Ontario Long Term Care Association

CEO Report
Presented to the OLTCA Board Meeting
January 29, 2013
Candace Chartier
CEO

Environmental Scan
Kathleen Wynne is the new leader of the Ontario Liberal Party and Premier of Ontario.
Wynne was elected on the 3rd ballot – her victory sealed when Charles Sousa and Gerard
Kennedy joined Eric Hoskins in support of Wynne’s candidacy
Wynne has said she will call the Legislature back on February 19 and introduce a budget
before the end of March (a Speech from the Throne would proceed the Budget)
Early stated priorities include welfare reform and public-sector wage restraint
Wynne has indicated support for current direction at MOHLTC
Wynne has said that she wants to avoid an election - Horwath and Hudak have given her a
list of demands to secure their cooperation
» NDP wants a public inquiry into the cancellation of two gas plants before the last election.
» Hudak wants government to get control of overspending, create jobs and respect the taxpayers
Tories launched critical radio ads highlighting that Wynne was part of the government
scandalized by ORNGE, eHealth, and gas-plant cancellations
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Environmental Scan
MOHLTC released of highlights of Seniors Strategy on January 8, 2013
OLTCA issued news release highlighting the adoption of a number of Association
recommendations, such as
» The development of an evidence informed capacity planning process
» Increasing short-stay respite and convalescent-care program capacity
» Exploring the ability of LTC homes to serve as community-care hubs
» Streamlining application and placement processes to improve flow to and from LTC
homes
» Providing additional training opportunities for staff and supporting them in releasing
time to care
Full report with 166 recommendations to be released in late January/early February
Dr. Sinha expected to stay on for a year to oversee implementation
Oltca examining recommendations – have invited Sinha to address Members on February 14.
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Contents
Updates Provided According to our Three
Strategic Priorities:
Build OLTCA Capacity to Deliver on
Association & Member Priorities
Secure Capital Redevelopment and LTC
Funding Reform
Promote Quality Long Term Care Programs
and Services
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Build OLTCA Capacity to Deliver on
Association & Member Priorities
Health System Funding Reform
Change Committee
» Quality in Community Care Reference Table
Operators’ Stakeholder Liaison Committee
All Agency Engagement Session Table
System Strategy Council
Funding Notifications
5

Health System Funding Reform
MOHLTC has published a three year outlook for HSFR however ministry
realizes that there is a potential gap in the framing of the QBP paradigm
across the continuum of care.
MOHLTC is aligning QBP approach with broader health system
transformation goals by taking a population-based approach focused on
high users to tie funding directly to user cohorts with the highest service
intensity needs and highest cost.
High Users are CCAC (focus for CCAC will be quality based funding on the
“complex” population) and LTC which includes the entire LTC population.
Aim is to implement Acute care QBP and Quality carve outs by April 1, 2013
and LTC/Community by April 1, 2014.
6

Community
While the Ministry has published a three-year outlook plan for HSFR, there is a potential gap in
the framing of the QBP paradigm across the continuum of care
Sector Year 1
April 2012
Hospital
(% of PBF Base)
Community Care
Access Centre
(% of PBF Base)
Long-Term Care
Homes (% of
overall Ministry
Funding)
Year 2
April 2013
Year 3
April 2014
HBAM 40% 40% 40%
Quality-Based
Procedures
6% 15% 30%
HBAM 10% 30%
Quality-Based
Procedures
HBAM (Case Mix) 60%
Quality-Based
Procedures
1% TBD
N/A
70%
65% 70%
7

What is Known I: A population-based approach focused on high users is
already an accepted foundation in the Community Sector (LTC and CCAC)
A population approach can be used to tie funding directly to user cohorts with
the highest service intensity needs and highest cost.
Aligned with broader health system Transformation goals.
Recognizes the complexity of care involved in these sectors (vs. episodic acute care).
Supported by several key stakeholders (M. Mottershead – former CEO OACCAC, Camille
Orridge, All Agency Forum).
High Users:
CCAC: Already use this Client Care Model to
stratify clients based on service intensity needs.
» Focus for CCAC quality-based funding
will be on the “Complex” population.
LTC: This cohort makes up the entire LTC
population.
OACCAC Client Care Model

The variations in patient care perpetuated by the historical funding approach,
warrant the move towards a system where ‘money follows the patient’
Hospitals, Community
Care Access Centres and
Long Term Care are the
first sectors incorporated
into the funding strategy
Health System
Funding Reform
Patient-Based Funding is
based on clinical clusters
that reflect an individual’s
disease, diagnosis,
treatment and acuity
Patient-Based
Funding
(70%)
Global
(30%)
Patient-Based Funding
will include HBAM and
Quality-Based Procedures
Health Based
Allocation
Method
(40%)
Quality-Based
Procedures
(30%)
HBAM is a ‘made in Ontario’ funding model that provides
organizational-level allocations informed by case-mix utilization
and aggregate cost, volume and types of patients and providers
Focus of new table for Community/LTC
Quality Based Procedures (QBPs) are clusters of patients
with clinically related diagnoses or treatments that have
been identified by an evidence-based framework as
providing opportunity for process improvements, clinical redesign,
improved patient outcomes, enhanced patient
experience and potential cost savings
9

Overarching HSFR Governance Structure
HSFR Initiative
ADM Leads: D. Young; S. Fitzpatrick
Executive
Committee
Steering
Committee
Change
Management
Committee
Director Committee
Academic
Advisory
Committee
Organizational-Level PBF Working Groups
(External/Internal)
*
*
Acute
Inpatient
and ER
Home Care
Long Term
Care
Homes
Local
Partnerships
Applied Learning Program
Small
Hospitals
*
In-Patient
Mental
Health
*
Inpatient
Rehab/CCC
*
Revenue
Working
Group
* Various sub-groups have been formed to further focus on detailed HSF components
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As implementation evolves, a number of products and knowledge-to-action
toolkits will be developed to help guide the work going forward
Clinical
• Quality-Based Procedures’ Definitions
• Best Practices
• Clinical Handbooks
• Clinical Engagement
Pricing/ Funding
• Quality-Based Procedure Best Practice Price
• Quality Overlay Framework
Capacity Planning
• Volume Management Strategy
• Capacity Utilization and Forecasting Program
Monitoring and Evaluation
• Integrated Quality-Based Procedure Scorecard
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AGENCY PARTNERS (e.g. CCO)
Clinical Expert Advisory Groups
Regional-Level *Regional-Level
Front-line Clinicians
Proposed stakeholder engagement/ outreach model to strengthen sector buy-in
Coronary
Pulmonary
Obstructive
Disease
Colonoscopy
Medical
Advisory
Council
Nursing
Advisory
Council
Congestive
Heart Failure
Stroke
Clinical Expert Advisory Groups
Co-Chairs
• Advise QBP clinical engagement
implementation strategy
• Identify clinical lead champions
• Strengthen clinical focus through engaging
physicians, nurses & other health disciplines
LHIN Leads
Forum
e.g. Primary
Care, Critical
Care, ED etc.
Chemotherapy –
Systemic
Treatment
Non-Cardiac
Vascular
Access
To Care
Advisory
Council
Provincial
Programs
Quality
Collaborative
Provincial-Level
All
Agency
Forum
Current
Clinical
Association
Networks
* Examples of communication channels include webinars, face-to-face sessions, workshops etc.
These sessions would be Ministry hosted in collaboration with the co-chairs of the Advisory Groups
Centre for
Effective Practice
12

Change Committee
Transformation Secretariat has launched a new initiative called “Health Links” that will facilitate
collaboration between local health care providers to coordinate care for high need clients.
Health Links will enable LHINs to work with all HSPs in a community to coordinate services and
care delivery at the client level, and enhance care delivery and patient experience, while reducing
costs.
Health Links are accountable to the LHINs. It is a voluntary initiative - several early adopter
communities have stepped forward to implement.
Next steps will focus on the following:
Sector Engagement: Alignment Discussions
1. Local Partnerships (LPs) - act as an advisory group, facilitating clinical, financial and decision
support and advice to and from the LHINs and MOHLTC
2. Leadership Series
3. QBPs: Plan for Engaging Clinical Leaders
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Change Committee
HSPs including LTCHs will have a role:
1. In co-chair the LP and proactively engage through the LP with a systems and organizational
perspective to inform local change and provincial HSFR approaches
2. Transfer knowledge back to host organization and surrounding provider partners
3. Ensuring key staff participate in training and education
4. Ensuring full organizational participation in local change management activities.
‣ Sector engagement sessions will be held to engage LHINs and HSPs through education and discussion of
the strategic and operational management of health system funding reform
‣ There will be three phases of education (self study modules which will be a pre-requisite for next phases, inperson
sessions focus on details of HSFR and webinars focusing on HBAM methodology). The initial
audience will be LHINs, Hospitals and CCACs.
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Change Committee
Quality in Community Care Reference Table
New table formed to implement HSFR across Community and LTC
Co-Chairs are Camille Orridge (CEO-TC LHIN) and Dan Burns (CEO-OACCAC)
Initial meeting held January 14 th and Terms of Reference and work plan were
outlined
Next steps:
Reviewing the Acute QBP Evaluation Framework – will it work for Community/LTC
Focusing on the “Functional Based QBPs”
Timeline: Implementation April 1, 2014…A LOT OF WORK TO BE DONE!!
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What is Known II: The evidence-based framework for selecting current QBPs…
Does this population contribute to a significant
proportion of total costs
Is there potential for cost savings or efficiency
improvement
Is there potential areas for integration
Will this contribute directly to Transformation goals
and objectives
Cost / Impact on
Transformation
Client
or
Residen
t
Groups
Using the Acute QBP Evaluation
Framework as a foundation, this
is what it could look like in the
Community.
Is there data and reporting infrastructure in place
Are there clinical leaders able to champion this
Can we leverage other initiatives or reforms
Feasibility
Availability
of Evidence
Known Quality
Issues
Is there a clinical evidence base for
best practices
Is costing and utilization information
available
Quality-Based
Procedures or
Populations
Is there a known quality issue or
variation in outcomes
Is there a high degree of practice variation
Health Quality Branch 16
16

Building on the Current State: Proposed approach to reframe the paradigm of QBPs across
the continuum of care
Population-
Based
Diagnosis-
Based
Cataracts *
Hip Replacement *
Knee Replacement *
Phase 2 Ortho ** †
Stroke **
Chemo (systemic treatment)**
Colonoscopy**
Coronary Artery Disease**
CHF**
CKD*
COPD**
Gastrointestinal Surgery ***
Thoracic Surgery ***
Spinal ***
Gastric Bypass ***
Phase 3 Ortho ***
Complex Chronic
Disease Model
Outpatient > Inpatient
Proportion of Care provided in the Community
Short-Term Cross-
Sectoral Episode
Inpatient > Outpatient
TBD
TBD
TBD
TBD
TBD
Acute Episodic
Inpatient only
These features are often
presented in populations such as
high-risk frail seniors and highneeds
mental health and
addictions
Functional-
Based
•Implemented in Year 1
** For implementation in Year 2
*** Proposed for implementation in Year 3
† CCAC to Provider level Outcome-Based Reimbursement for Year 2
>2 co-morbidities ***
Wounds / ulcers *** †
Palliative ***
Risk of falls ***
Behaviours / dementia ***
Frail elderly ***
Health Quality Branch
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High Level Timelines
Jan 13
Policy options analysed,
recommend approach
selected
Nov 12
Governence
established
Jan 2013 - Jun 2013
Expert advisory consultations
to validate approach, define
cohorts, select indicators.
Jul 2013 - Aug 2013
Impact modelling
Sep 2013 - Jan 2014
Sector engagement
Apr 2014
Additional Community
funding changes
(MOH to CCAC/LTC)
Jan 2014 - Mar 2014
Develop funding pkgs &
sector support products
Jan 2013 Apr 2013 Jul 2013 Oct 2013 Jan 2014
October 2012
Jan 13
Quality in the Community Reference
April 2014
Table Kick-Off Meeting
Apr 2013
Wound, Hips, Knees
Outcome-Based Reimbursement (OBR)
Implementation CCAC to Provider
(approx 5% of CCAC purchased services budget)
Apr 2014
Additional CCAC to Provider
level Outcome-Based
Reimbursement (OBRs)
18

Operators’ Stakeholder Liaison Committee
Updates provided on several areas including:
Fire Safety/Sprinklers: Both associations thanked for feedback, some monies will be forth
coming and some earmarked for 2013/14. A proposal has been drafted and is making its way
through the system. There will be greater flexibility to use funds.
Physician On Call Funding: Funding changes retroactive to April 2011. Proposed change would
give $12.5K to homes with less than 30 beds, $15K to homes with 30-149 beds and homes with
150 beds and over would get $100/bed.
Funding flexibilities: Found through the webinars and Q&A process that some small homes
weren’t budgeting annually, recognize there may be pressures and will monitor, variable cost
issues for products, looking at local solutions for areas like transportation costs, etc.
Regulatory changes: Regulatory changes are moving through approvals - increasing
convalescent care beds, shift from choice-base to referral-base, clarifying CIS reporting,
specialized units, more flexible HHR.
19

All Agency Engagement Session Table
“The pursuit of quality and evidence is a driving force for HSFR and should always be at
the forefront of healthcare decisions”
Work is underway to define community-focused QBPs. It is critical that socializing of stakeholders
begins on the proposed approach to reframe the paradigm of QBPs across the continuum of care.
As QBPs are reframed across the continuum of care, it will become increasingly important to link
QBP activity to primary care.
As implementation evolves, the Clinical Expert Advisory Groups will need to be expanded to
include representation from other sectors (i.e. community, LTC, primary care etc.) and patient
advocates.
LHINs need to be a part of the QBP planning and decision-making process, specifically around
service capacity planning.
20

System Strategy Council Table
Table consists of: OHA, OLTCA, OAHNSS, OHCA, ALPHA, AOHC, OACCAC, CAMH, LHINs,
LINK, etc.
Meetings dedicated to roundtable discussion on advancing the quality agenda in Ontario.
Focusing on Quality Outcomes and asking every association to share their sector priorities as well
as insights into opportunities, challenges and tactics for accelerating quality improvement efforts.
LHINs provided an update on 3 current areas of focus and invited feedback from the Council;
advancing Ontario’s transformation agenda, partnership for palliative care and aligning primary
care
Overall key messages:
‣ general agreement that preliminary priorities of Transformation Secretariat were appropriate
‣ significant alignment in quality focus across sectors but some at different stages
‣ areas of opportunity for collaboration and alignment and creating shared accountability for clients
‣ LHINs will play important role in facilitating alignment of quality priorities
‣ HSFR will be the enabler for transformation
21

Secure Capital Redevelopment
and LTC Funding Reform
Capital Redevelopment Update
Capital Redevelopment Table
22

Capital Redevelopment Update
Refocusing our Capital Redevelopment package from meetings held in the fall
(OLTCA Roundtable, Deputy Minister meeting, Don Young meeting).
Contacting Brenda Blackstock (IO update) and Catherine Brown (senior table) to reestablish
the senior table that was set up before the holidays.
Additional analysis as outcome from FLC meeting to strengthen our conversations.
Opportunity through different tables we are at to position capital redevelopment.
Recommendations from Dr. Sinha’s report sets foundation for discussions:
“76. The Ministry of Health and Long-Term Care should improve the quality of longterm-care
accommodation by improving the conditions for redevelopment of the
approximately 35,000 remaining B, C and upgraded D beds.“
23

The Future of LTC
“No one disagrees that we eventually will have to build more LTC homes in
Ontario. However, many agree that there also exists significant potential to
divert demand for long-term care to other care settings, settings that would
likely be more cost effective and more aligned with patient preference…While
providing long-term care for those with complex needs and limited options to
remain at home in the community will always remain the predominant focus of
this sector, increasing the capability of the sector to provide a variety of shortstay
care services could better support the transitional care needs and
preferences of older patients …This transition also needs to encompass the
provision of enhanced palliative care services and the development of the
necessary expertise to deliver it, in long-term care homes, to enable more
residents to die in these homes rather than in a hospital setting.”
- Dr Samir Sinha, p. 116-117
24

Capital Redevelopment Table
Senior table requested to deal specifically with a viable Capital Renewal Program.
Table cannot exceed 15 people and would include:
2 each from OLTCA/OAHNSS
2-3 from LHIN
Rachel Kampus/Catherine Brown
Peter Kaftarian/Don Young
Brenda Blackstock
Technical person for design (MOHLTC)
Other (potentially financing and maybe on an ad-hoc basis), if this is the case we
would negotiate to have an OLTCA expert float in on an ad-hoc basis for the various
modules (design, financing, funding, etc.)
25

Promote Quality Long Term Care
Programs and Services
LTC Roadmap Executive Advisory
MOHLTC/PSHSA Indicator Project
Worker Consultation Task Group
26

LTC Roadmap Executive Advisory
Reviewed the 3 key priorities for the committee; Access, Quality and Integration
Access
Goal: Maximize the utilization of diversity of LTC long and short stay programs (right
care, right place, right time)
Quality
Goal: Strengthen sector capacity, human resources, innovation and quality
Integration
Goal: Support LHIN-based system capacity planning to match programs and
population needs along the continuum
Goals and Outcomes reviewed and roundtable input for final editing, action items will be
reviewed next meeting.
Next steps: Associations to set up meeting to determine enablers and levers to build
capacity and opportunities to come back to the table with how we can align with
community supports, integration opportunities and sector capicity (OLTCA, OAHNSS,
OARC and OLTCP).
27

MOHLTC/PSHSA Indicator Project
A new project, that will be seeking input and advice about potential healthy
and safe workplace indicators through an online survey.
The Public Services Health and Safety Association is leading the initiative
funded by the Ministry of Health and Long-Term Care (Health Force
Ontario)
Goal is to recommend a set of core, consensus-based healthy and safe
workplace indicators for Ontario’s healthcare
http://www.healthyworkenvironments.ca/Resources_Indicator_Project.htm.
The project timelines are tight, responses required mid-January to early
February, 2013. On The Radar asked you to share the survey with your
members. First meeting of group to be held March 1 st .
28

Worker Consultation Task Group
The Ministry of Labour has initiated the new Vulnerable Worker
Consultation Task Group.
Task force selected by Ministry with diverse group across all sectors
(posted on ministry website)
Aim is to provide critical stakeholder perspectives and advice to the ministry
on the prevention of workplace injuries and occupational diseases affecting
vulnerable workers in the Province of Ontario.
Initial launch and consultation meeting February 27 th 2013.
29

Other Updates –
Changes in the Ministry
Wiesia Kubica who has many files such as fire prevention, rate reduction, envelope
eligibility, direct funding agreements, task force agreement and some regulatory
matters has now moved to the Deputy Ministers office from the PIC Branch.
Margaret Allore who we were getting closer to and was Catherine Brown’s right hand
has moved to fill Wiesia’s position in PIC Branch.
Theresa Nowak will now be overseeing rate reduction but not sure about all the other
files…
30

Other Updates –
Changes in the OLTCA Staffing
Len Koroneos acting as interim for Director Financial Policy and Planning, transition
plan completed for file status and update.
Four Corners have been acquired and have completed positing and candidate profile,
currently posted on Longwoods, Linkedin and CCHL-CCLS.
Lesley Atkinson has decided to step down from the Director Communications and
Public Relations and continue to stay on to assist with Task Force on Resident
Safety, candidate interviewed for position by Brian Pollard, Lesley and Pat McCarthy.
Job posting closed Jan 11 th for Senior Communications Advisor and interviews being
held January 31 st and February 1 st .
Draft job description for Senior Policy Advisor to be approved by Board and job
posting will go out immediately thereafter.
31

Other Updates –
Changes in the OLTCA Staffing
Complete analysis completed of all job descriptions in office, all positions reviewed
with staffs and sign off received as well as all Performance Appraisals completed (all
job descriptions now current as of January 2013 and will be reviewed annually
thereafter).
Brian Baillie job description revised with enhanced responsibilities to ensure office
operations and management consistent and administrative communication plan
adhered to.
Senior staff and all staffs team communications scheduled on a weekly basis.
Once all staffs in place an assessment will be conducted by Senior Staff to assess if
any gaps – goal is to have full staff complement in order to support Strategic Plan
and Business Plan by May and then Staff Retreat to solidify relationships and share
all job descriptions in order to facilitate an effective and efficient office environment.
32

Other Updates –
Website Update
Complete analysis to be completed of status of website by….
Website Action Plan developed and all staff inserted responsibilities and updates to
get a picture of what is required and what has been completed to date.
Updates to be incorporated and discussed at Senior Staff and team communications
scheduled on a weekly basis.
Once new analysis completed we will review timeline and cost and feasibility of
website being completed by March 31 st . A phased in approach is being planned.
Online Directory completed.
Assessment will include 2 - 4 days review the material from each staff outlined in
action plan as well as, reviewing the Drupal website, reviewing the CiviCRM
implementation, meeting with people to understand what remains to be done and
what the priorities are, and writing a phased action plan with estimates to be delivered
about the end of next week...
33

Looking to the Future -
Opportunities and Challenges
It is going to be a very fast paced environment and it will be essential for
members to establish key new relationships in the community (Health Links).
We have to be proactive and put solutions forward of the “possibilities” during
this “redefining LTC” shift…balance our asks with what we feel we can deliver.
More effectively utilize the relationships between our member homes and
commercial members and highlight the innovative quality landscape that we
foster.
Communication across membership and with stakeholders is crucial - we need
to establish a plan/process so that we have an ear to the ground and can keep
ahead of the curve…
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