Contributed by Dr. Darren Larsen, Chief Medical Officer, OntarioMD
This post originally appeared at http://darrenlarsen.com/ontario-health-teams-are-coming/ on April 23, 2019
Change is happening now in Ontario healthcare. It has been needed for some time, but a new provincial government with a demand to deliver high value for public dollars is making the change imminent.
So what, exactly, is “value”?
Value is best defined as quality (in all of its domains) divided by cost. It can be measured from different perspectives (patient, provider, health system, funder) but ultimately the same principle applies. If we increase safety, efficiency, effectiveness, access, patient-centered care, and equity, and can offer it up for a lower provincial spend, we have created value.
How do we do this in our current fractured, silo-based system? It won’t be easy. It will involve letting go of certain tightly held concepts. It will include changing structures we have known for a long time. It will take real leadership.
Whether we are patient, clinician, or Ministry planner, many feel the same systemic pain. We see a lack of integration, from the services being delivered to the data generated from them. Transitions in care present substantial risk. There are rarely warm handoffs between care settings. They are loaded with processes that remove personal accountability and ownership for outcomes (good and bad). We measure, but not necessarily the right things. We default to quantitative metrics when the tough job of looking at behaviours and action drivers (qualitative measures) are ignored or downplayed. The opportunity for change is here.
If transitions in care are the primary points of error and loss in healthcare, what is being proposed to change things?
Integrated care delivery systems are a potential solution. In Ontario, the government hopes the new Ontario Health Teams will accomplish this. They will take many forms, as they should, to reflect the diversity in local healthcare needs. Some will be led by communities and primary care. Others will have a hospital at the core. All are meant to blend and offer seamless care for individuals, whether in the home, doctor’s office, nursing home, or hospital. They will succeed in some fundamental principles, common to all.
- People moving between different parts of the system will have care coordinated as they move between them.
- Navigators will assist to ease the burden for those who have no energy or experience in health maneuvering.
- Care follows the person, and eventually, so will the funding to pay for that care (bundled payments)
- There are financial rewards for doing better than a benchmark (gainsharing) and disincentives for doing worse (risk-sharing).
- Silos of care delivery will be brought down. Acute care hospitals, home care in the community, primary care and long-term care form a fluid continuum for patients who move between them. There will be a focus on difficult care areas: mental health, palliative, frail elderly, indigenous patients, those disproportionately impacted by the social determinants of health.
- Information will flow between system partners to ensure that accountabilities and decisions made are factual and data-driven
- The patient will experience nothing about them without them. They will have full transparency into where they are in their journey. As an extension, they deserve full access to their health records.
- Digital care tools will be front and centre. Use of existing digital products created by system partners will be recommended or mandatory. New tools that meet current needs will be designed and allowed. Options for patients will include virtual visits, e-consultations, data viewing portals, online booking, and more.
- Records systems will not be one size fits all but important core data will be exchanged between all of them for transparency and appropriate care.
- Privacy and security rules will be modernized to reflect patient needs and expectations for sharing, while still ensuring that only the data which must move for care moves. Personal health information is held sacred.
- Antiquated procurement rules built to reduce the risk of failure will be modernized to allow new technology to move forward quickly. Legacy products that no longer, or perhaps never did, meet our needs should not be protected
- Changes that succeed will be promoted and celebrated along with failures as learning points for others. Lessons will be shared between OHT’s.
The pace of change we are seeing now in Ontario is unprecedented. In a few short months, we have witnessed the introduction of Bill 74, creation of the Ontario Health super-agency, and movement toward integrating acute, primary, community and long-term care. As a doctor, I welcome this change because the current path is unsustainable. As a patient, I cannot wait for change because I never want to be trapped in a transition. For myself and for my patients, I demand transparency along my healthcare journey. Moreover, as a health system leader, I am incredibly enthused as I watch duplication and waste disappear, silos break down, honesty and transparency increase, and higher quality care produced at a lower cost. All of this motion should lead to a healthier, more sustainable, coordinated system. We will, when we get this right, have reduced the burden of care for all, and will be well on the path to real improvement!