Family Medicine Matters

Ontario Health Teams - More Details, Where To Next?

April 18, 2019

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Now that the Guidance Document for Ontario Health Teams is out, we are getting a better idea of the changes that are to come. The Ministry of Health and Long-Term Care has a vision that all Ontarians will be part of an Ontario Health Team (OHT), so that their care is connected, coordinated and comprehensive. These teams will likely include hospitals, home care, primary care and long-term care of a region. Sounds great – and sounds a lot like the Patient Medical Home/Neighbourhood vision that we at the OCFP have been talking about for a long time. 

Another aspect of this is that these OHTs will hold the purse-strings and accountability for the care that will be delivered by health service providers in that area (note - NOT the funding for non-salaried physicians at this time). 

How to get there is the challenge of the day. From what we have read and discussed with our stakeholders and the Ministry, the process to get the province “covered” with these teams will take years and it will happen in a decentralized fashion. The call is now out for proposals from groups or providers and organizations that feel they may be “ready” to form an OHT, and that subsequent waves will eventually include all Ontarians (and by extension, all family physicians/NPs who look after them).

In the first wave, interested groups of organizations and providers must submit the Self-Assessment, and based on their ‘readiness’, some of the selected teams will be invited to submit a full application, aiming to be functional by the Fall of 2019. Groups that need to do more work to bring partners together or have more work to do to ensure the key priority sectors of at minimum hospital, home care, community care, and primary care are included will be given feedback about how to improve their application. The Ministry will “matchmake” with overlapping proposals in a geographic area. 

The “Self Assessment” is a set of 48 questions that groups must rate themselves on items such as:

  • “Your team is able to define a geographic catchment that is based on existing patient access patterns”
  • “Your team is able to deliver coordinated services across at least three sectors of care and you have adequate service delivery capacity within your team to serve the care needs of your proposed Year 1 target population (e.g., your team includes enough primary care physicians to care for all Year 1 patients)”
  • “You are able to propose a plan for physician and clinical engagement and ensuring inclusion of physician and clinical leadership as part of the team’s leadership and/or governance structure”
  • “You can identify opportunities and targets and can propose a plan for improving access, transitions and coordination of care, and key measures of integration”
  •  “You are able to propose a plan for how you would include patients, families, and/or caregivers in the governance structure(s) for your team and put in place patient leadership”
  • “Your team is working to pursue shared quality improvement initiatives that integrate care and improve performance”
  •  “Your team is working towards an integrated funding envelope and identifying a single fund holder”
  •  “Your team is able to propose a comprehensive plan to improve information sharing and resolve any remaining digital health gaps, consistent with provincial guidance regarding standards and services”

The OCFP is committed to the goal that “no practice is left behind” amidst all the changes taking place.  We have voiced concerns that the required criteria will continue to advantage those areas that are already well coordinated, or where partners can easily identify team-based practices. We have also expressed that the “have-not” practices and communities need more targeted assistance – the Ministry needs to look to geographic areas that do NOT get proposals and promote development of that integration. We encourage you to participate in local meetings to find out what’s happening so that you can make the decision about being involved or not at this time, based on what’s happening in your region.

Reading the above, many of you will feel that this is far away from the day to day of your clinical life. There are uncertainties about what it means for the individual family physician to be a part of these teams. Please see the recent Pulse on Family Medicine for a fuller discussion of these issues.  

It is clear that most practising physicians will rely on other organizations to administer these OHTs. Some primary care practices such as FHTs and CHCs may be well positioned to lead in some regions. It is abundantly clear from lessons learned in Canada and internationally that these teams will only succeed with significant physician involvement in the design and leadership. It is reassuring to see that the Ministry of Health recognizes this. It remains to be seen if they fund this physician leadership – but this is an essential component; significant leadership cannot be done off the side of your desk, nor for free. 

We are working with the Section on General and Family Practice, the OMA and AFHTO to ensure family physician leadership is part of the health system changes – you can find our respective submissions on Bill 74 (the bill that creates these OHTs) here: OCFP; OMA; AFHTO. We have different roles in advocating for family physicians and their patients in this future forward.

The OCFP has launched the Leadership in Primary Care Network to help support family physician leaders in their communities. We have started a virtual primary care community with The Change Foundation and AFHTO that will bring together those in primary care that are interested in leading in their context and supporting meaningful system change within the Ontario healthcare system – click here to register. We continue to speak to the Ministry of Health and Long-Term care about feedback from our members and opportunities to support you through these changes. 

We will do our best to find answers to your questions. Email us at [email protected]. You can also email our colleagues at the Ontario Medical Association at [email protected] and the Section on General and Family Practice at [email protected]. As well, if you are part of or want to connect with a Family Health Team, you can reach out to the Association of Family Health Teams of Ontario at [email protected].

The OCFP is committed to advocating for family physicians to be able to deliver the highest quality of care for our patients. Let us know what you think, help us be your voice.

 

Jennifer Young
President