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Mississauga Halton LHINCSS and MH&A Sector

MeetingApril 27, 2011

MHLHIN Financial Update

Finance Team - MH LHIN, Paulette Zulianello and Mirella Semple

Q4 – OHRS/MIS Trial Balance -due May 31/11Q4 CAT on WERS – due June 7/11**Annual Reconciliation Report – due June 7/11** Q4 Supplementary Reporting for Initiatives

(Service Maximum and Aging at Home) – June 7/11Audited Financial Statements –due June 30/11 ** Note: extension till June 30/11

Finance Update Due Dates (As per Schedule C – MSAA):

MSAA MH LHIN Specific Performance Obligation –due June 7/11Template will be sent to all providers by MH LHIN Similar to last year

Finance Update

Other misc due dates:

Finance Update

Please Note the following:

Q4 CAT ToolNo change to the CAT Tool for Q4.Q4 should be up on WERS early May. Quick Reference Guide will also be on

WERS.

Finance Update Please Note the following (con’t):Annual Reconciliation ReportUser Guide for ARR will be on WERS ARR is similar to last year;- small minor changesNo training for ARR- Please read user guide!!!LHINs to support technical issues on the ARR, however, Financial Management Branch (FMB) to support policy

issues, etc.Audited Financial Statements- 1 copy to FMB and 1 copy

to the LHINs

Finance Update SRI – SELF REPORTING INITIATIVE

Replace WERS IBM –off the shelf software solution (FileNet Business

Process Manager Suite)Planning target is to have Q2 quarterly reports on SRIHealth Data Branch will be responsible for training

providers not LHINsDiscussions on when WERS will be turned off is still

pending.Stay tuned for further communication

Questions

Program Evaluation FindingsSDL and Restore Programs

CSS and MH&A Quarterly Meeting

Dr. David SheridanSHERCON ASSOCIATES INC.

www.shercon.ca

April 27, 2011

Study Overview

“Restore” program at MLC and 8 SDL programs

Followed ICES evaluation model

March 2010 - October 2010

Conducted by SHERCON ASSOCIATES INC.

Supervised by Project Oversight Group

Data Sources

1. Documents2. InterRAI CHA Data Base

3. Client Files4. Focus Groups

5. Key Informant Interviews

Data Quality

• Mix of quantitative and qualitative methods• Tests of statistical significance

• Comprehensive, representative samples• Consistent interview and focus group themes

• Good face validity of findings• Clear, consistent and converging evidence

Restore

• Chart abstractions• Monthly reports to LHIN

• CCAC pre/post assessment data• Client follow questionnaire

• Focus groups with referring organizations

Restore: MAPLe Scores Declined

MAPLe: Intake DischargeMild 0 13Moderate 62 65High 38 22

Restore: CHESS Scores Declined

CHESS: Intake Discharge0 17 311-2 78 583+ 6 11

Restore: Locomotion Scores Improved

SRI: Intake Discharge0 13 611-2 33 253+ 53 14

Other Restore Findings

Personal hygiene, bathing and ADL scores also improved

Low levels of hospital recidivism

High client satisfaction

Positive stakeholder perceptions

Some improvement opportunities related to intake and assessment

Restore Conclusions

1. Converging evidence that the program is achieving intended outcomes

2. Freeing up acute care beds by diverting people from LTC to lower cost

alternatives

Right care in the right setting at the right time for the right cost

Supports for Daily Living

• InterRAI CHA data base• 893 clients served by 8 programs

• MH LHIN data• Client satisfaction surveys

• Client focus group• Interviews with system stakeholders

Supports for Daily Living

2010 2008CCS 2+ 26 9MAPLe 4-5 40 23CHESS 3+ 21 5Hosp. Admits 1+ 31 15ER Visits 1+ 26 15SRI 1+ 80 69IADL 7+ 77 57DRS 3+ 19 10CPS 3+ 4 3

Hospital Use (Prev. 90 Days)

CHESS(Changes in Health, End-Stage Disease & Signs & Symptoms)

SDL Mobile

Mobile clients are:• More impaired

• More resource intensive• Higher MAPLe priorities

• More frail• More ER visits

• Less independent and self-reliant• More difficulty with IADL• More depressive disorders

All items are statistically significant

Other SDL Findings

ER visits diverted: 1,046

Clients returned from hospital sooner: 379

Clients removed from LTC wait lists: 54

Clients diverted from LTC: 224

Clients returned to community from LTC: 18

Other SDL Findings

High client satisfactionPositively viewed by system stakeholders

High level of coordination and collaborationImprovement opportunities related to upstream

communication, continued coordination, streamlined assessment

SDL Conclusions

1. Converging evidence that the program is achieving intended outcomes

2. Freeing up acute care beds, diverting ER visits and reducing demand for LTC

Right care in the right setting at the right time for the right cost

Moving Forward

1. Continued communication and coordination

2. Improved information management3. Leverage success of both programs

Utilizing SDL MH Evaluation Results from the CHA

What Have We Built in the Land of inter-RAI C.H.A.?

MAPLe REFRESHA Learning Opportunity

A Learning Opportunity

Term

M

A

P

L

e

Definition

• Method (of)• Assigning• Priority

}Levels

www.interrai.org

John P. Hirdes, Ph.D.

Rate of Nursing Home Admissions Within 90 Days of Assessment by MAPLe Level, Ontario, Derivation Sample

MAPLe Comparisons

MAPLe Comparisons – Bricks & Mortar + MOBILE

CRUDE COMPLEXITY SCALE (CCS) REFRESH


Crude Complexity Scale (CCS)

3 Different summary

scales combined

CPS Score

ADL Score

CHESS Score

Understanding CCS – Random Threshold Selection

Random Threshold Selection

• CPS score of 3+(moderate to very severe cognitive impairment)


• ADL score of 1+ (set-up help required to full dependence)


• CHESS score of 2+ (moderate to high level of frailty & instability in health)

Understanding Crude Complexity Scale (CCS)

0 = None

• Does not exceed the thresholds of CPS/ADL/CHESS

1 = any single

domain

• Exceeds the threshold of either CPS/ADL/CHESS

2 = two or more domains

• Exceeds the thresholds of any 2 of CPS/ADL/CHESS

Sum the # of domains that exceed the threshold

Understanding CCS - Example

Exceeds CPS of 3+

Does not exceed

any other domain

Therefore, CCS = 1 Domain

CCS-What All SDL Looks Like

MOBILE + Bricks & Mortar CCS Comparisons

RESOURCE UTILIZATION GROUPS (RUGS) REFRESH


Understanding RUGS (III)

Indicates variable costs of caring for

persons with different needs

Most resource intensive is

assigned a RUGS Category

Those less resource intensive assigned a

lower level RUGS category

Those that do not fit in any of

the previous RUGS

categories, PA1 or PA2 given

Those assigned a PA1 or PA2

have lowest ADL impairment =

least resource intensive

RUGS Comparison – Which Colour is the Least Resource Intensive?

Preventative Health Measures

Conclusions

Greater acuity of clients in SDL than was present in past

SDL has reduced or delayed referrals to LTC

Value (cost effectiveness & cost/benefit) for investment funding is evident

Conclusions

No SDL “MOBILE”

No SDL “Bricks & Mortar”

(1) 296 more clients utilizing

LTC beds

(2) $5.3 mill savings not

realized

Conclusions

SDL “MOBILE”

SDL “Bricks & Mortar”

(1) Viable alternative to LTC for appropriate

clients

(2) Community can support a higher level of need & risk with a “frequency” model of

care

A word about ALC & Roles of SDL

SDL a cornerstone piece of the ALC strategy

Target for the MH LHIN for 2010/2011 is 8.0% ALC utilization in Acute Care beds

Currently almost all other LHINs in Province are in double digit numbers for ALC rates

A word about ALC & Everyone’s Contribution

April 24th, 2011

5.5%

Thanks for Listening – and I Really Do Think We’ve Built a Better Model

LHIN Community Engagement Guidelines and Toolkit

April 27, 2011

55

Overview•The LHIN Role in Ontario’s Health Care System

•LHIN’s mandate to engage

•Best practices, consistent standards and performance obligations

56

57

The LHIN’s role

58

• Guided by published principles• Early identification of community/project stakeholders• Flexibility in approach – time, method, logistics

conducive to community involvement and the needs of the project

• Open & transparent process – including the sharing of inputs & outputs

• Continuous process improvement informed by evaluation

Best practices in Engagement

59

LHIN Community Engagement Guidelines and Toolkit

•Definition of Community Engagement•Definition of Stakeholders•Performance Obligations of the LHINs

60

• Community engagement refers to the methods by which LHINs and HSPs interact, share and gather information from and with their stakeholders.

• The purpose of community engagement is to inform, educate, consult, involve and empower stakeholders in both health care or health service planning and decision-making processes to improve the health care system.

• Community engagement activities can be ongoing or project specific, outbound or inbound

Defining Community Engagement

61

• Stakeholders are general public, communities, political entities or organizations that have an interest and what to share their views in the outcomes of the initiatives

• For the purpose of stakeholder identification, “communities” can be interpreted to mean geographic locations, communities of interest or communities of practice.

Defining Stakeholders

62

PerformanceObligations• An annual LHIN community engagement

strategy or plan that is publicly available and reviewed on an annual basis.• The LHIN uses the community engagement guidelines to support project

planning and decision making.• Participant evaluation must be integrated into every community

engagement plan and inform future engagement planning.• The LHIN will establish an evaluation committee including external

reviewers to which it will submit its completed community engagement templates at least once within every three- year planning cycle.

• The LHIN demonstrates how community engagement results have been tabled to LHIN decision-makers, including the Board for planning, funding and any decision-making process. Engagement can be rolled-up, where appropriate.

63

What does that mean for HSPs?

• Health service providers are encouraged to consider these principles in planning their own community engagement activities, although they are not mandatory.

Voluntary Integration• HSPs have to engage the stakeholders as part of any voluntary integration of services and a community engagement report has to be submitted with the proposed voluntary integration initiative.

64

Community Engagement Guidelines

Available on the MH LHIN website at mississaugahaltonlhin.on.ca

Transitional Aged Youth Pilot for MH LHIN

April 27, 2011

65

SIGMHA and the MH LHIN have committed to the Transitional Aged Youth Protocol and 4 month pilot

• Pilot sites: one in Halton and another in Mississauga

• May-August 2011

• 22 participating agencies are using a client-focused, case conference model.

• PDSA process to evaluate, make improvements and recommendations for a LHIN-wide transition process

The Goal of the Pilot

• Is to implement a seamless transition for young people, 16-24 years with mental health or addictions from the youth sector into the adult sector.

• In order to attain our goal, agencies and service providers are working together to proactively coordinate services and ensure a seamless transition across various services and systems.

Roles and Responsibilities• The youth case manager/counselor is the “care coordinator or system

navigator” and is responsible to transition the client in a seamless and supportive manner.

• The care coordinator to attend the first visit to the adult agency to support & mentor the client and continue follow up for 3 months.

• Agencies review the common client referral and making the commitment to accept the client into their services

• Adult agencies to make every effort to accept client based on client needs and risk, not on agency waitlists.

• Adult agencies to look at services to create a more youth friendly approach

Mississauga Pilot co-leads:• Mary Lynn Porto at Trillium Health Centre. • Lisa Bachmeier at Associated Youth Services

of Peel,

Halton Pilot co-leads:• John Smith at Support and Housing Halton. • Kjeld Thomasen at Community Youth

Programs.

Hardest part in the pilot?Is the youth with a mental health or addiction problem…

trying to transition into the adult sector.

Home First Approach

Mississauga Halton LHIN

Philosophy and Approach

•A philosophy that requires shifting the health care team mindset to consider what will it take to get patient home

•If you came from home…we will do what we can to help you return home

•Providing care at home results in better outcomes

•Always consider “home first”

•LTC should only be considered after all other options have been eliminated

•LTC is a social process and the hospital is not the right place for this transition to occur

Implementation Initiatives

•Discussions started in Spring 2007 with LHIN about how to reduce ALC – Home First was not the first solution

•Great effort was put in to improving the LTC application process…and facilitating transfers to LTC

•September 2008 LHIN and CCAC did what was counter intuitive with LTC process and started the home first discussion and implementation at Halton Health Care

•Process was quickly replicated at Trillium Healthcare and Credit Valley Hospital

Implementation Initiatives

•Changed workflow processes and identified roles and responsibilities of the health care team

•Actively promoted a culture shift through education, coaching and consistent messaging

•Leveraged enhanced community resources through LHIN investments

ALC – Now What ?

•Identify barriers that may prevent timely discharge and refer to appropriate health care professional to resolve discharge related issues

•Consistent messaging to patient and family that when acute stay is over patient will be discharged home from hospital

•CCAC CM to assess all options in collaboration with hospital healthcare team for discharge home to support patient in safe transition – maximize use LHIN investments

•If no option for patient to return home exists, then and only then does the LTC application process being. Requires review and sign off by CCAC Hospital Manager and Hospital Manager of Patient Flow

MH LHIN Investments•Wait at Home (Enhanced and Long Term Care)

-Enhanced PSW services to facilitate hospital discharge with appropriate supports at home while planning/waiting for LTC or other destinations

•Stay at Home

-Program designed to prevent hospitalization or admission to LTC-Enables clients to remain in their homes with enhanced PSW service-Limited spaces (106)…so waitlisted

•Restore Program

-Specialized LTC unit for acute patients who require additional time to enable them to return home. Patients have higher acuity than a typical LTC resident-Not acute care or permanent…meant to be transition to home

MH LHIN Investments•Supports for Daily Living (SDL)

-Service provides an average of 1.5 hours of non-medical PSW services per day available at any point through the day, 365 days/year-Hours can be split up in to multiple visits during the day (i.e., 15 minutes later in the day and 30 minutes at night)-Services are designed for clients with overnights needs or more frequent visitation than offered by CCAC-Service includes attendant care for prescheduled tasks, homemaking services and safety/reassurance checks via phone or in person-Bricks and mortar, Mobile and hub models in MH LHIN area

•Expansion of Adult Day Program:

-Creation of specialized programs identified to meet a greater need such a patients with Alzheimer’s or patients requiring bathing programs

Hospital Executive Sponsorship

•Hospital management actively promoted culture shift through education, coaching and consistent messaging

•Hospitals were involved in the discharge committees

•Each Hospital VP met with LHIN and CCAC to discuss high level ALC strategy

•LHIN crafted a letter to all hospital CEO’s and CSS sector to identify that all parties were jointly responsible for the Home First approach…so in essence a contract was formed

•Hospital Senior Leadership was heavily involved in engaging physician/allied health by continuously communicating with them to reinforce the Home First philosophy

Physician Engagement

•It is essential for senior hospital leadership to be involved in engaging physicians to reinforce key messages

•Engagement strategies include initial and follow up meetings as well as communiques with physicians

•Physicians require a hospital point person to address any concerns, discharge challenges

•Physicians were provided with a script:“your active medical treatment in hospital is complete. The

health care team will now meet with you/family to discuss discharge options. Staying in hospital is not an option”

Supporting Home First Approach - Committees

•LHIN, CCAC and Hospital VP’s meet regularly to discuss element of Home First including high level strategy, funding and sustainability

•Monthly ALC Operational Committee enacts all the plans for Home First: Committee consists of CCAC Director, Hospital Managers, CCAC Hospital Managers, LHIN ALC Strategy Lead, Community Support Agencies, and Long Term Care

Joint Discharge Operations Committee (JDO)

•Each hospital holds “Joint Discharge Operations” (JDO) meeting daily or 3x/week. Membership includes Hospital Discharge planners/social workers and CCAC Case Managers. Chaired jointly by Hospital Manager of Patient Flow and Hospital CCAC Manager

•Purpose of JDO to discuss each ALC patient, identify barriers to discharge, assign accountabilities and work toward timely discharge

Funding

•MH LHIN has committed to funding the community investments in place as long as the evidence is provided that they are providing results

•MH LHIN is continuously looking at the results where their funding is going to maximize investments (i.e. evaluating the community investments)

•MH LHIN will continue to fund CCAC for service maximums (for WAH programs) with evidence to support need. Currently have over 700 clients receiving enhanced services in the community

Risks and Challenges

•Sustaining cultural shift is the key challenge of Home First

•Home First requires a transformation change in the way healthcare is delivered

•Physician Resistance: Physicians need to be supported to understand the quality of care provided in the community

•Issues of perceived risk when sending patients home and how well the patient’s care needs will be supported

Addressing Challenges

•Must improve communication systems between community partners, hospital and CCAC (Kaizen event November 2010)

•Must be more proactive in getting clients to community programs and services

•Must focus more on admission avoidance

Results to date – 2009/10

Restore program has saved the equivalent of 35 acute care beds

250 people have been diverted from LTC placement

700+ patients discharged through Home First Approach

60% decrease in ALC-LTC days from 08/09 to 09/10

30% reduction in new LTC applications from all hospitals

10% decrease in LTC waitlist in 2009

Questions ?

Contact information:Janet ParksED/ALC Strategy LeadMississauga Halton [email protected] ext. 226

Mississauga HaltonDiabetes Regional Coordination Centre

MH Community Services

April 27th 2011

Provider SupportDecision

Information Management Systems

Service SystemDesign

Personal Skills andSelf Management

Supports

RegionalCoordination

Centre

InterdisciplinaryCare Team Defined Roles and Responsibilities

Patient is a Partner in Care

Evidence Based Practice

Mississauga Halton Regional Diabetes Coordination Centre

Client RegistryEMR

Provider Portals

Educating the public, especially

those at risk about diabetes and ways to prevent it (ODS)

Support patients managing their disease (ODS)

Educating the public, increasing the adoption of approved practice guidelines and proven care and

treatment (ODS)

Continually improving local health coordination

(ODS)

Identifying gapsin health care and addressing them

(ODS)

Setting targets for clinical performance, enhancing

accountability and monitoring (system) performance (ODS)

Organization FrameworkMinistry of Health

And Long Term Care

Halton Healthcare Services

Diabetes RegionalCoordination Program

Regional Director Diabetes Regional Coordination Centre

Clinical OutreachCoordinator

Health InformationConsultant

Primary Care Physician Lead

Self Management Project Manager

Self ManagementCoordinator

Administrative Lead

Self Management Project Agreement

MOHLTC _ HHS

DRCC Agreement MOHLTC – HHS

MH DRCC Regional Goals• The DRCC will work with the MOHLTC to develop accessible current information

resources to support care provider/individual self management of diabetes and measurement of Mississauga Halton diabetes care system performance

– Web enable knowledge resource– Web enable secure linkages between diabetes care providers and related services– GIS based information in each sub-LHIN area

• Enable the client to be an active partner in the planning and delivery of his/her health care – Client, family and care provider education to promote use of self management tools by people

with/at-risk of diabetes and their health care professionals – workshops, certifications, CME’s

• The DRCC will promote implementation of clinical/provider interventions in the treatment of diabetes that are based upon proven best practices to

– Link Healthcare and other providers of diabetes and related to services to establish and comprehensive and connected network of quality services to individual with or at-risk of diabetes, their families.

– Engagement of physicians and other primary care practitioners in the adoption of electronic systems access and uptake in the MH LHIN.

– Standardize the approaches taken to Diabetes care in MH region to align with evidence based best practices

• Develop an integrated System of Diabetes Care capable of planning and delivering comprehensive high quality services in a coordinated and efficient manner

MH DRCC Accomplishments to Date– Provider engagement in primary care, foot care, community pharmacy,

Diabetes Education Programs, CCAC and hospitals– Service Inventories of DEP, CCAC and FHT diabetes programs– Service inventories of foot care providers and community pharmacy in

progress– Engagement of CDA, OMA and Renal Network– 3 – year Regional Plan for Implementation of ODS in Mississauga

Halton– Newsletter Release in May– Completion of capacity analysis for MH region diabetes services– Establishment of key networks

• Diabetes CONNECT – a network of leaders in diabetes programs• Foot Care Network – cross region representatives from foot care sector• Community Pharmacy Network – cross region pharmacists keenly interested

in advancing the potential of community pharmacy• Primary Care and Endocrinology engagement

Initial High Level Inventory FindingsInventory of Diabetes Education/Management Programs/Family Health Teams

CCAC, Chiefs of Family Practice – November/January 2010• MH region is well resourced re: diabetes education programs (5) but programs are not always located close

to needs, nor do they offer the same services – Funding resources widely vary– Mix of Pubic and Private models

• Family Health Teams (7) vary with respect to their vision for care, especially Chronic Disease, and how effectively they use their internal diabetes management resources but generally potential resources are available for growth and development,

• Referral to diabetes programs in Halton are slightly declining, while referrals are growing in Mississauga neither pattern is well understood at this point (total patients in 2009 - 22,650 of 76,658 people with diabetes are registered in Diabetes Education Programs and/or through FHT services, likely includes double reporting)

• A common referral form and care pathway is needed to ensure access and follow up for patients and families

• Diabetes/healthcare provider roles are not clearly understood nor are they consistently utilized

• Services are not easy to find for clinicians or clients

• Information is offered in many different ways (good!) but messaging is not always consistent (not so good!)

• Web enabled services offer excellent potential for patient learning, skill development and communication between care givers…and patients but are not in use (except in isolated cases)

• We have great opportunities to develop an excellent service system in MH Region!

MH Region and Diabetes

Diabetes Prevalence in MH Region 8.8%/76,658 people (9th highest)

Diabetes Prevalence in Ontario 9.3%/961,204 people

Percent of Ontarians with Diabetes Who Received Tests within Guideline Periods

0%20%40%

60%80%

100%

Test for HbA1c Test for Lipid (LDL-C) Retinal Eye Exam All 3 tests within timelines

0%20%40%

60%80%100%

Ontario MH Region Target

TARGET

MOHLTC/ICES – October 2010Does not include hospital lab data

Working with the DRCC Partnership Opportunities

Promotion of evidenced based clinical/service provider best practices

Healthcare consumer education and skill development

Public and provider information sharing

Measure Ontario MH Region Ranking Comment

Number % Number % N=14

Est. # People with Diabetes 961,204 9.3% 76,658 8.8% 5 Aug-10

Rate of Inactivity (2008-09) 51.2% 50.8% 7 2008-9

% Overweight/Obesity (BMI 25+) 51.7% 45.4% 2 2008-9

% People Attached to Primary Care MD

96.4% Not available

Physician Use of Incentive Management Codes

36.9% 33.8% 11 March 2010 MD payment for quality care

ER visit for hyper/hypoglycaemia per 100,000 pop with Diabetes

1,111 783 3 Aug-10

Dialysis rate per 100,000 pop. with diabetes

780 692 3 2008-9

Infection/ulcers/amputation per 100,000 pop. with diabetes

3,244 2,692 2 2008-9

Heart Attack per 100,000 pop. with diabetes

1,163 829 1 2008-9

Other Measures of Interest – ICES, October 2010

Self Management (SM) and SM Supports are core components of Ontario’sChronic Disease Prevention and Management Framework - Each LHIN hasa SM strategy in place, based with the DRCC in MH Region – Project fundingto support regional programs has been provided in 2011-12 for one year.

PROVINCIAL GOALImproving health outcomes for Ontarians through the provision of selfmanagement education and skills training to • individuals with chronic disease and • Healthcare and community service professionals and staff

Mississauga Halton Self Management Strategy/Project

Self Management Goals for MH LHIN• 300 individuals through Maximize Your Health Programs offering

Stanford model

– Generic ‘evidence based’ program offering life skills including positive thinking, communication, goal setting, problem solving, working with healthcare professionals, nutrition, exercise, peer support

– Taught by certified leaders (clinicians and volunteers experiencing chronic disease)

– 25 6-week workshops/2.5 hour sessions/12 people

– Materials and instruction at

Healthcare/Service Provider Training• 300 Clinicians/Staff offered ‘Choices and Changes’ evidence based

model developed by the Institute for Healthcare Communication Canada

– Communication skills aimed at reinforcing self management during clinical interactions

– 4.5 or 6 hours sessions direct instruction offered at sites of employment or alternate locations

– 150 clinicians/staff will receive follow up mentoring through on-line, direct session, peer study applied to work setting

– Materials and instruction at

In order to build regional training capacity, the MH DRCC Self Management

Strategy also includes

• Opportunities to become certified leaders for individual based programs AND opportunities to become certified staff trainers without costs, all training related expenses are supported including

– Travel and accommodation

– Tuition

– Materials

– Training opportunities to consolidate skills

For more information please Contact the MH DRCC Self Management Strategy

Megan Suddergaard, Project Manager905-338-4432 Ext. [email protected],Betty Clara, Project Coordinator905-338-4432 Ext. [email protected]

Please take a

Business Card

mailto:[email protected]:[email protected]

Mississauga Halton LHINIntegration Framework

CSS and MH&A Quarterly MeetingApril 27, 2011

LHIN Integration

LHINS are responsible for taking care of the full range of people’s health care needs. No one organization or

sector can create the continuum of services that people need. LHINS are the local group that

organizes services together, fill in gaps and help people access the services they need.

103

Integration: Why?

• The LHIN is responsible for planning, funding and integrating its local health system.

• LHSIA provides the tools that enable the LHIN to fulfill its statutory obligations.

• However if the LHIN doesn’t recognize when to use these tools, the LHIN may miss opportunities.

104

Integration: Why?

• Improve the patient experience.

• Optimize access to care and coordination of services – “Right care, right time, right place.”

• Administer a safe, high quality health care system.

• Ensure public accountability, transparency and stewardship of public resources.

105

Legislative Context• The Local Health Services Integration Act, 2006 (LHSIA) S.24

provides that each LHIN and each health service provider (HSP) shall separately and in conjunction with each other identify opportunities to integrate the services of the local health system to provide appropriate, co-ordinated, effective and efficient services.

• The LHSIA S.23 broadly defines a “service” to include all services or programs provided by HSPs to the public:

• A service or program offered directly to people

• A service or program supporting a direct service (laundry)

• A function that supports an organization that provides either a direct or a supporting service or program (payroll).

106

Legislative ContextThe LHSIA S. 2 defines “integrate” to include:

•Coordinating services/interactions between different persons and entities

•Partnering with others in providing services or conducting operations

•Transferring, merging or amalgamating services, operations, or entities

•Starting or ceasing to provide services

•Ceasing to operate, dissolving or winding-up operations

107

LHSIA provides LHINs, the Minister and HSPs with several tools to integrate services:

Integration Type Description

LHIN FundingLHSIA S.19

The LHIN uses its funding authority to promote integration of services with/between HSPs.

Facilitated/Negotiated IntegrationLHSIA S.25

The LHIN and/or HSPs explore appropriate integration strategies and the LHIN facilitates or negotiates integration with the HSPs. LHIN issues a written integration decision.

Required Integration LHSIA S.26 The LHIN orders HSPs to integrate services.

Voluntary IntegrationLHSIA S.24 & 27

A HSP at their own initiative, plan to integrate services funded by the LHIN. LHIN may issuea stop order within 60 days

Minister’s OrderLHSIA S.28

The Minister orders a HSP to integrate i.e. cease to operate, dissolve, wind-up its operations, amalgamate or transfer operations.

108

PatientExperience

Back-office / Non-clinical

Clinical Services

Organizational

Awareness Coordination Full Integration/ Amalgamation

Mississauga Halton LHINIntegration Framework

LEVEL

CAT

EG

OR

Y

109

MH LHIN Integration Framework

• Incorporates patient-focused, high-quality care concepts, as per “Excellent Care for All” and other provincial strategies.

• Assists in organizing and assessing the value of current integration initiatives.

• Enables the identification and prioritization of future integrations.

110

Integration: LevelsConsolidation of responsibilities, resources, and financing in a

single organization or system

Structured, inter-organizational collaboration; allowing providers to retaining separate business models and/or entities

Informal or formal exchange of knowledge, best practices, policies and proceduresAwareness

Coordination

Full Integration / Amalgamation

111

Back Office / Non-clinical• IT infrastructure• Finance and Accounting• Purchasing• Administration & HR

Clinical Services• Clinical practices & standards• HHR• Delivery of service

Organizational• Relationships between organizations (e.g. MOUs)• Polices and procedures• Vision & Mission• Organizational culture

Integration: Category

112

Integration: Principles

Improving the patient experience• Increasing patient satisfaction.

• Promoting client engagement and empowerment.• Reducing caregiver burden.

• Maximizing quality of life.

113

Integration: Principles (cont.)Optimizing access to care and coordination of

services – “Right care, right time, right place”

• Determining appropriate capacity and siting of services• Delivering equitable and fair service• Reducing unnecessary touches in the system and

duplication of service• Optimizing handoffs and reducing wait times

114

Integration: Principles (cont.)Administering a safe, high quality healthcare system

• Maximizing positive health outcomes• Eliminating adverse events• Integrating evidence-based best practices and

standardized care• Establishing “Centres of Excellence”; culture of sharing,

continuous improvement and innovation

115

Ensuring public accountability, transparency and stewardship of public resources

• Fiscally accountable, value-added, cost-effective service delivery

• Properly administered service agreements and obligations

• Efficient and effective performance evaluation and risk assessments

• Maintained, responsive and accurate performance monitoring systems

Integration: Principles (cont.)

116

Integration Type: MH LHIN ExamplesIntegration Type Examples

LHIN FundingLHSIA S.19

Clinical : Regional Specialized Geriatric ServicesEnhanced Community Palliative CareLTC Behavioural Unit

OrganizationalRegional Antibiotic Stewardship Program

Back OfficeMedworxx Clinical Utilization Tool

Facilitated/Negotiated IntegrationLHSIA S.25

Back OfficeCommon IT/IM Director for THC & CCAC

Required Integration LHSIA S.26 N/A

Voluntary IntegrationLHSIA S.24 & 27

ClinicalRegional Renal Program

OrganizationalRegional hospital physician Credentialing

Back OfficeShared Hospital DI Scheduling co-ordination

Minister’s OrderLHSIA S.28 N/A 117

Integration: Future Opportunities

Integration Opportunities under consideration for 2011/12Clinical Services

Regional Complex Continuing Care and Rehab ServicesEnhanced CCAC role

OrganizationalPalliative Integrated Client Care Project

Back Office/ Non-clinicalE-referral Resource Matching & Referral (RM&R) tool

118

An Update from the MH LHIN Steering CommitteeApril 27th, 2011

Every client who receives Community Support Services (CSS) will have an initial standard assessment and appropriate reassessments completed according to established guidelines.

This will:◦ Enable appropriate care planning and service

navigation◦ Ensure the right service at the right time◦ Facilitate data sharing and reduce repeated story

telling◦ Provide high quality data for reporting at

client/HSP/LHIN/Provincial levels◦ Identify potential areas for process redesign and

streamlining

CCIM engaged to support rollout of interRAI-CHA to CSS Sector across Ontario

Time-limited project

Originally project timeline extended by 8 months

Provincial CAP project to conclude December 2013

Some larger Provincial and/or National CSS Agencies have opted out of a regional implementation and chosen to work with CCIM from a Provincial level

Goal is to achieve efficiencies and consistency in implementation across the Province

Includes:◦ Red Cross◦ VON◦ CNIB◦ Ontario March of Dimes◦ Canadian Hearing Society

MH LHIN EA’s unique in the Province as only SDL Program implemented not agency-wide

EA’s provided opportunity to enroll in modified training with CCIM OR take full module training with Phase 1 group

EA’s began CSS CAP training with CCIM in November 2010 and will be completed in May 2011

The screener tool should:◦ Capture a minimum data set for all CSS clients

(quick snapshot)◦ Help to navigate clients to the right door(s) for

service◦ Identify need for further assessment◦ Identify risk

Goal is to avoid unnecessary over assessment of a client

Provincial Working Group evaluated 4 screener tools

None of the tools met all purposes Recommended 1 tool met most of the criteria Recommendation included testing the draft

tool to ensure its appropriateness for its diverse use within the CSS sector

Provincial Steering Committee recommendation still before MOHLTC awaiting approval

interRAI-CHA Either CHA or Screener Screener Assessment Recipient

Adult Day Services, Personal Support, Respite,

Assisted Living, Supportive Housing,Attendant Outreach, Caregiver Support

Caregiver Support, CrisisIntervention, Homemaking,Overnight Care

Meals on Wheels, Congregate

Dining, Transportation, Home Maintenance, Vision Impaired Services, Deaf, Deafened and Hard of Hearing Care Services

Psycho Geriatric, Aphasia,Hospice

interRAI – CHA Clients requiring comprehensive

assessment to inform care planning – ADL/IADL

support EitherClients may require a

screener or a comprehensive

assessment

ScreenerClients requiring

single service for low intensity support

Assessment RecipientClients have completed assessment – program

supports care plan

MH LHIN Steering Committee assigned MH LHIN CSS agencies (in some cases, programs) to either Screener or interRAI-CHA categories based on:◦ Complexity of needs of clients served◦ Model of service delivery

Some agencies have programs that fall into both interRAI-CHA and Screener◦ Begin with the CHA and implement Screener for

programs as necessary later

Steering Committee learned portion of funds was available to support CHA implementation in 2010/11 (also some funds available in 2011/12)

Removed CSS Agencies in MH LHIN from 10/11 funding pool:◦ Early Adopters (previously funded)◦ Provincial Implementers (funded at Provincial level)◦ Screener Agencies (to be funded at later date)

Informally surveyed those agencies left to see if they were ready or eager to implement quickly (able to spend some funds prior to March 31, 2011) – those became Phase 1 group

Those who were not ready to implement quickly were placed into Phase 2 group – eligible for 2011/12 funds

Steering Committee set out allotments to fund for hardware and software licenses (based on previous experience with Early Adopters) from 2010/11 implementation funding

Late in process learned that software licensing allotment may not be enough to support newpurchase of vendor software – need more time to evaluate

Decision: Hardware - fund Phase 1 and some Phase 2 agencies for hardware to support implementation from 2010/11 funding

Decision: Software - only fund Phase 1 agencies who require licensing for existing software from 2010/11 funding

MH LHIN Phase 1Group◦ kick-off on May 5th , 2011◦ complete implementation by October 27th, 2011

MH LHIN Phase 2 Group ◦ dates still to be confirmed◦ Projected to begin late August 2011 and conclude in February 2012

Provincial Working Group met 2 days in January 2011 and 2 days in March 2011

Developed Guiding Principles, Benefits, Definitions and Evaluation Criteria

Drafted a shared assessment model – model to be finalized in May and presented to Provincial Steering Committee for approval at May meeting.

Funds were provided to develop training centre for use by all CSS providers in MH LHIN to support the Common Assessment Project

Hardware was purchased prior to March 31, 2011 to furnish the Centre

Space is provided by Alzheimer’s Society of Peel

Location is: 385 Brunel Road, Mississauga, ON L4Z 1Z5 (Kennedy & Britannia) Software/licensing still to

be determined

CCIM has developed some useful resources –can be found on their website:

www.ccim.on.ca(select CSS, then interRAI-Community Health Assessment, then

select “Member Area”)

Includes materials in the following areas:Forms and GuidesPreparing for ImplementationManaging ImplementationEducation and TrainingTechnologyPrivacy and Security

http://www.ccim.on.ca/

LHIN newsletters: In Progress◦ Highlights CCIM Common Assessment project activities

(IAR, CSS CAP, CMH CAP, and LTCH CAP)◦ Timing: Quarterly◦ Audience: LHINs and HSPs◦ Available: https://www.ccim.on.ca/LHIN/default.aspx

CSS CAP Updates◦ Provides information regarding CSS CAP Steering

Committee decisions and implementation progress across the province

◦ Timing: Every 2 months◦ Audience: CSS Sector◦ Available: https://www.ccim.on.ca/default.aspx

https://www.ccim.on.ca/LHIN/default.aspxhttps://www.ccim.on.ca/default.aspx

Name Agency Service AreaTheresa Greer Heart House Hospice HospiceAllison Price LInks2Care Various (Home Help, Home

Maintenance, SH, Respite etc.)Lorena Smith Seniors Life Enhancement

CentresAdult Day Services

Laurie Martovich Region of Halton Adult Day Services & SDLJoanne Hawkins Acclaim Health Home Care Support ServicesChris Rawn Kane Alzheimer Society of Peel Specialized SupportCaroline Countryman VON Home Care Support Services &

SDLSteve Kavanagh Peel Senior Link SDLLisa Gammage Nucleus Independent Living SDL & Attendant OutreachJudy Bowyer MH LHIN N/aAshim Rizki CCIM N/a

Mississauga Halton LHIN�CSS and MH&A Sector Meeting�Slide Number 2MHLHIN �Financial Update�Slide Number 4 Finance Update � Finance Update � Finance Update �Questions Study Overview Data Sources Data Quality Restore Restore: MAPLe Scores Declined Restore: CHESS Scores Declined Restore: Locomotion Scores Improved Other Restore Findings Restore Conclusions Supports for Daily Living Supports for Daily LivingHospital Use (Prev. 90 Days)CHESS�(Changes in Health, End-Stage Disease & Signs & Symptoms) SDL Mobile Other SDL Findings Other SDL Findings SDL Conclusions Moving ForwardUtilizing SDL MH Evaluation Results from the CHAMAPLe RefreshA Learning Opportunity Slide Number 33Rate of Nursing Home Admissions Within 90 Days of Assessment by MAPLe Level, Ontario, Derivation SampleMAPLe ComparisonsMAPLe Comparisons – Bricks & Mortar + MOBILECrude Complexity Scale (CCS) RefreshCrude Complexity Scale (CCS)Understanding CCS – Random Threshold SelectionUnderstanding Crude Complexity Scale (CCS)Understanding CCS - ExampleCCS-What All SDL Looks LikeMOBILE + Bricks & Mortar �CCS ComparisonsResource Utilization Groups (RUGS) RefreshUnderstanding RUGS (III)RUGS Comparison – Which Colour is the Least Resource Intensive?RUGS Comparison – Which Colour is the Least Resource Intensive?Preventative Health MeasuresConclusionsConclusionsConclusionsA word about ALC & Roles of SDLA word about ALC & Everyone’s ContributionThanks for Listening – and I Really Do Think We’ve Built a Better ModelLHIN Community Engagement �Guidelines and Toolkit��April 27, 2011OverviewSlide Number 57Slide Number 58Slide Number 59Slide Number 60Slide Number 61Slide Number 62Slide Number 63Slide Number 64Slide Number 65Slide Number 66The Goal of the PilotRoles and ResponsibilitiesSlide Number 69Hardest part in the pilot?Home First Approach�� Mississauga Halton LHIN��Philosophy and ApproachImplementation InitiativesImplementation InitiativesALC – Now What ?MH LHIN InvestmentsMH LHIN InvestmentsHospital Executive SponsorshipPhysician EngagementSupporting Home First Approach - CommitteesJoint Discharge Operations Committee (JDO)FundingRisks and ChallengesAddressing ChallengesResults to date – 2009/10Questions ?Mississauga Halton�Diabetes Regional Coordination CentreSlide Number 88Organization FrameworkMH DRCC Regional GoalsMH DRCC Accomplishments to DateInitial High Level Inventory Findings�Inventory of Diabetes Education/Management Programs/Family Health Teams�CCAC, Chiefs of Family Practice – November/January 2010MH Region and DiabetesSlide Number 94Slide Number 95Slide Number 96Mississauga Halton Self Management Strategy/ProjectSlide Number 98Slide Number 99Slide Number 100Slide Number 101Mississauga Halton LHINLHIN Integration Integration: Why?Integration: Why?Legislative ContextLegislative ContextLHSIA provides LHINs, the Minister and HSPs with several tools to integrate services:Mississauga Halton LHIN�Integration FrameworkMH LHIN Integration FrameworkIntegration: LevelsIntegration: CategoryIntegration: PrinciplesIntegration: Principles (cont.)Integration: Principles (cont.)Integration: Principles (cont.)Integration Type: MH LHIN ExamplesIntegration: Future Opportunities CSS Common Assessment ProjectCSS CAP Overall ObjectiveProvincial TimelineProvincial ImplementationEarly AdoptersPurpose of a Screener ToolSelection of a Screener ToolCSS Assessment Needs by Client & ProgramScreener vs. CHA in MH LHINCSS CAP Implementation Funding 2010/2011Phase 1 vs. Phase 2Funding Plan ChangesCHA Implementation TimelinesShared Assessments UpdateIntegrated Assessment RecordRegional Training CentreHelpful ResourcesAdditional ResourcesQuestionsMH LHIN CSS CAP Steering Committee