jun. 13/07
TRANSCRIPT
Performance Contract and Allocation Overview
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What LHINs Do
Community Engagement
Funding & Allocation
Patient Centred Integration &
Service Coordination
Local HealthSystemPlanning
IHSP:Setting the Course
Accountability& Performance
Monitoring
Accountability Agreements:Executing the Course
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What does this look like?
• What has changed as of April 01, 2007?
• Accountability
• Tool kit
PerformanceMonitoring
Accountability Agreements:Executing the Course
Accountability & Allocation
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What changed as of April 1?
• World on April 2 was much the same as it was on March 31, 2007
• Transformation will be evolutionary not revolutionary
• Health Service providers will want to prepare for:– An increased emphasis on accountability– A focus on integration & improved service
coordination– new approaches to everything from funding to health
system planning
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5 main areas where changes will be felt…
1. Increased integration and improved service coordination
2. Increased local decision-making about funding and allocation
3. Greater emphasis on local health system planning
4. Increased community engagement
5. Enhanced Accountability
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1. Increased integration & improved service coordination
• After April 01, health service providers will:• Be responsible for aligning their service planning
within the CE LHIN IHSP• Implement the directions for integration laid out
in the accountability agreements with CE LHIN• Demonstrate continuous improvement in service
integration & coordination (LHIN will help facilitate shared best practices through our Comm Engagement structures)
• Take part in agreements and initiatives designed to further provincial objectives in areas such as access, quality, safety and efficiency
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2. Increased local decision-making about funding & allocation
CE LHIN will…CE LHIN will…• Assess priorities at local
level• Determine service
configuration based on priorities
• Allocate funds accordingly
• Monitor fiscal performance & contribution of providers to ensure integration & system sustainability
Health Service Providers Health Service Providers will…will…
• Submit business and service plans as required by their accountability agreements (same tools for now)
• Be responsible to CE LHIN for delivering programs and services on budget
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1. Was it vetted by your Planning Partners?
2. Is it aligned with the IHSP?
3. Is it evidence-based and can it be measured & monitored? (ie., Decision
Support & Performance Monitoring) 4. Who shares accountability for its
accomplishment? (ie., agreements & funding)
5. How will it be resourced?
Integration Initiatives/Ideas/Proposals
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3. Greater emphasis on local health system planning
CE LHIN will…CE LHIN will…• Identify and determine
local health care priorities• IHSP to reflect local
priorities & link with provincial strategic directions
Health Service Providers Health Service Providers will…will…
• Continue to participate in CE LHIN Planning exercises
• Align strategic plans with those of CE LHIN
• Provide input and info necessary for CE LHIN Plans
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5. Greater Accountability
• People have the right to expect accountability from their governments– To that end, CE LHIN has entered into an
accountability agreement with MoHLTC
• Patients have the right to expect that their health service providers will be accountable for the quality of services they provide– To that end, part of CE LHIN mandate is to negotiate
Service Accountability Agreements (SAAs) with health service providers
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Accountability FrameworkSTEWARD MANAGER PROVIDER
MOHLTC
LHIN 1
LHIN 2
LHIN 14
Hospitals
CCAC
LTC Homes
CSS
MH&A
CHC
OTHER
Strategies and Directions- Tools and processes are being developed
Operationalizing Policy/Direction-Tools/processes NEED to be developed
∙ ∙ ∙∙ ∙ ∙
∙ ∙ ∙∙ ∙ ∙
. . . .
Ministry of Health & Long-Term Care & the Central East LHIN
Accountability Agreement
2007-2010
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Primary Agreement
• Purpose– Supports the collaborative relationship between the
MOHLTC and LHIN to carry out the made in Ontario solution to improve the health of Ontarians
– To set out the mutual understandings between the MOHLTC and the LHIN of their respective performance obligations in the period from April 1, 2007 to March 31, 2010
• The Primary Agreement was previously reviewed and approved in principal in November 2006
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Agreement Components• Primary Agreement• Schedule 1 General• Schedule 2 Community Engagement, Planning and
Integration• Schedule 3 Local Health System Management• Schedule 4 Information Management Supports• Schedule 5 Financial Management• Schedule 6 Financial Processing Protocols• Schedule 7 Local Health System Compliance Protocols• Schedule 8 Integrated Reporting• Schedule 9 Allocations• Schedule 10 Local Health System Performance
Where are we at?
BuildingBuilding BlocksBlocks for YEAR 1
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Times have changed:Environmental Scanning is secondary to community
engagement, it quantifies what we heard.
Our mantra: “Heard, Found, Do”
What We HeardWhat We Heard
(Engagement)(Engagement)
What we FoundWhat we Found
(Environment Scan)(Environment Scan)
What We Will DoWhat We Will Do
(Our Plan)(Our Plan)
1.1. Number of Number of seniors in CE seniors in CE LHIN and its LHIN and its Planning ZonesPlanning Zones
2.2. Population Population Growth of Growth of SeniorsSeniors
3.3. Estimate of Estimate of dementia cases dementia cases in seniorsin seniors
Priority 1: Priority 1:
• Seamless care Seamless care for Seniorsfor Seniors
1.1 Improve access to LTC 1.1 Improve access to LTC home serviceshome services
1.2 Enhance coordination 1.2 Enhance coordination of servicesof services
1.3 Reviewing and building 1.3 Reviewing and building specialized geriatric specialized geriatric servicesservices
SeniorsSeniorsSeniorsSeniors
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We Own This Now!
DATA
Raw counts of units of service, or total expenditures. Databases.
INFORMATION
Profile of agency, type of service, location, number of clients
KNOWLEDGE
How agency provides service, other similar services, total units of service in an area related to population.
WISDOM
How to make programs work together to improve health outcomes for a given population
Very limited use of data to inform operations and
planning.
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Environmental Scan Overview—Our Population:
• The CE LHIN geography stretches from the culturally diverse and densely populated Scarborough planning zones to the rural and less populated areas of Haliburton Highlands, and northern sections of the City of Kawartha Lakes and Peterborough Counties.
• The population is mainly concentrated in the South West area of the LHIN, with almost 50% of the population in Scarborough.
• The area is characterized by rapid population growth for certain age groups and the second highest percent of those over 65 in the province. The 85+ age group will increase by over 91% between 2001 and 2016, and the 14-17 age group will decrease by 0.5% for the same period.
Central East Planning Zone Populations (%) for 2006
Kawartha3%
Peterborough8%
Scarborough Agincourt - Rouge
19%
Northumberland Havelock
4%
Haliburton Minden0.3%
Durham West24%
Durham North / Central
3%
Scarborough Cliffs - Scarborough Center
26%
Population Growth Rates for CE LHIN
-20.0%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
% G
row
th f
rom
20
01 B
ase Y
ear
Youth (14-17)
Adult (18+)
65-74
75+
85+
Total
Central East LHIN Planning Zones
Haliburton Highlands
Kawartha Lakes
Peterborough City & County
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Example: Historical Wait-time TrendingDiagnostic Imaging - CT Scan
0
20
40
60
80
100
120
Jul-05
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-07
Feb-07
Wai
t-Ti
me
in D
ays
(90%
Com
plet
ed W
ithin
)
Peterborough Regional Health Centre Lakeridge Health Corporation
Rouge Valley Health System Scarborough Hospital
CE LHIN Avg Target (28 Days)
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How we Approach Performance
Trend Analysis CE LHIN MRI Trend All Data
60
70
80
90
100
110
120
130
Months
Wai
t T
imes
June 2006 to Jan. 2007
Projected February 2007 to August 2008
March 2008 Estimated WT for MRI = 115
It takes people to bend this curve
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Example of Health System Goal Managed by LHINs
Improve patient-centredness, integration and quality of health services
Performance measure Score• Total number of days percentage alternative level of care (ALC) 9.3%
LHIN (1) Scorecard
Performance measure• Total number of days ALC• Target
Score
7.72%7.72%
LHIN (2) Scorecard
Performance measure• Total number of days ALC• Target
Score
10.30%8%
LHIN (3) Scorecard
Performance measure• Total number of days ALC• Target
Score
11.04%9%
Hospital (A) Report
MLAA -negotiation MLAA -negotiation MLAA -negotiation
Health System Scorecard
Performance measure
• Total number of days ALC
Score
10.55%
LHIN (2) negotiates service agreements with its hospitals on an individual basis regarding strategies for managing alternative level of care patients: e.g. conducting a daily utilization review to determine appropriateness of admission and readiness of discharge; developing closer relationships with community agencies, etc.
LHIN
1
LHIN
2
LHIN
3
5.27%
10.30%
11.04%
Hosp A
10.55%
3.85%
12.09%
Hospital (B) Report
Performance measure• Total number of days ALC
Score
3.85%
Hospital (C) Report
Performance measure• Total number of days ALC
Score
12.09%
Hosp B
Hosp C
2003-0 4
2002-0 3
2001-0 2
2000-0 1
1999- 00
9.10%
1998- 99
10.10%
9.75%
9.62%
8.79%
9.20
%
Average across Ontario
Average across LHIN (2)
Strategy Map
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The “Toolkit”: Accountability Agreements
HSP Service Agreements
HAPS/HAA
Funding Proposals
Capital/PCOP
Risk Management
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The “Toolkit”: Population-based Funding
Funding Letters - Summer 2007
In-Year Pressures - Late Summer 2007
Transfer Payment & Allocation Management
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A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.
- Sir Winston Churchill
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DiscussionAnd
Questions