April 18, 2019

Pulse on Family Medicine: Primary Care Policy Update

Ontario Health Teams: What They Are & How To Get Involved

You have likely heard about Ontario Health Teams (OHTs) and are wondering if you should get involved. Here are some facts about OHTs and information for you to consider.

  • In late February, the government introduced Bill 74, The People’s Health Care Act, 2019, and the future creation of Ontario Health (the super agency) and Ontario Health Teams (OHT). The Ministry of Health and Long-Term Care has now released a Guidance Document for groups of providers and organizations interested in becoming an OHT.

  • OHTs are a new way of organizing and delivering services in local communities, with the goal to deliver more integrated and seamless care – and ultimately a better care experience for providers and patients alike. In an OHT, healthcare providers such as doctors, hospitals, and home and community care will voluntarily come together and self-organize to deliver the full continuum of care to patients.

Below is more detail on what the coming OHTs mean for you, how you can get involved, and how the process will unfold – including assessments and applications, supports available and timelines for the first cohort of OHTs. You can also read the OMA’s Frequently Asked Question on the government’s transformation efforts here.


Tell me more about Ontario Health Teams (OHTs).

Ontario Health Teams are groups of providers and organizations that come together voluntarily to deliver integrated care to a defined geographic population. An OHT must have the ability to deliver at least three types of health services, such as primary care, home care, acute care, mental health and addictions, and palliative care, among others.  In the initial stages of OHT rollout, priority will be given to teams focused on a minimum three services that include hospital care, primary care, home care and/or community care.

As OHTs roll out to full maturity, they will be expected to provide the full continuum of care for all but the most highly-specialized conditions, operating through a single clinical and fiscal accountability framework.


What will governance of the OHT look like? Who will lead the OHT?  

Each OHT will determine the governance structure that best suits its context and the needs of patients.

Participating providers will enter willingly into a partnership agreement with one another which outlines terms and conditions of partnership including conflict and performance management, information management, risk and gain sharing and a performance plan.   

Although underlying funding mechanisms among partners will not change in the near term for OHTs, at maturity each OHT will be funded through an integrated funding envelope.


What is meant by risk/gain sharing?

Risk and gain sharing is an approach that aligns incentives across different providers and sectors. Each partner in a risk and gain sharing arrangement shares financial gains from efficiencies. For OHTs, all savings must be redirected into front line care. The OMA is seeking further information. We will keep you informed as we learn more. 


Are OHTs mandatory for family doctors?

Involvement is voluntary and depends on interest and readiness to engage. The vision is for all providers to eventually be part of an OHT. Some groups of doctors already work very closely with partners in the health system and will be in a position to participate at the outset. Other family doctors may be invited to get together with other providers or organizations to become part of an OHT that is being developed/considered. Others may decide they are not able or interested in participating at this time.

The first wave of OHTs will largely be defined by the providers who choose to participate in them and who already have experience working together. For example, many Family Health Teams and their Family Health Organizations/Networks are poised to lead OHTs. We know, based on evidence from other jurisdictions, that there will be a greater chance of success with family physician leadership and co-design in the implementation and management of these new organizations.

If you are not ready to participate in one of the initial OHTs, you will have further opportunities to participate in the broader OHT rollout over the coming years. As noted above, and referenced in the Guidance Document, the goal is to eventually have all healthcare providers and organizations be members of an OHT and ultimately all patients.


Tell me more about the steps involved in becoming an OHT.

Creating an OHT will involve establishing the corporate entity that will “be” the OHT and manage the funding and coordination of care, 24/7, across the continuum of care. Under that OHT umbrella, providers will voluntarily come together to deliver more seamless care. 

There are four key steps on the path to becoming a designated OHT. More details can be found in the attached backgrounder from the Ministry.

OHTs will be implemented in phases, and through a continuous intake process to allow groups to get organized and complete the process. 

  • Step 1: Self-assessing readiness. Interested groups of providers and organizations assess their readiness and together begin working to meet key readiness criteria for implementation.
  • Step 2: Validating Provider Readiness. Based on self-assessments, groups of providers are identified as being ‘In Discovery’ or ‘In Development’ stages of readiness*.
  • Step 3: Becoming an OHT Candidate. Groups of providers that meet the readiness assessment will be invited to submit a full application to begin implementation of the OHT model.
  • Step 4: Becoming a Designated OHT. OHT Candidates that are ready to receive an integrated funding envelope and operate under a single accountability agreement can be designated. As noted, underlying funding mechanisms among partners will not change in the near term for OHTs, at maturity each OHT will funded through an integrated funding envelope.

* In Discovery: Following self-assessment submission reviews, those deemed to be in the beginning stage of readiness will receive access to supports to continue working towards further readiness. In Development: Those teams that demonstrate a higher degree of readiness to become OHTs will be invited to prepare and submit a full application. Full applications will be evaluated and those that demonstrate a higher degree of readiness for implementation will be invited to participate in an in-person visit.
-- The assessment process will be repeated until full provincial coverage of Ontario Health Teams is achieved.


Why should I get involved in an OHT?

Being on the frontline of care, family doctors know the system and are uniquely positioned to shape how integration and navigation can be improved. Further, as noted in our recent submission on Bill 74, the involvement of family physicians – anchored in primary care and through the principles of the Patient’s Medical Home – will be central to making this comprehensive, integrated care a success.

  • Improved care delivery. By joining an OHT, which is designed to provide a more seamless and integrated care experience for providers and patients, the expectation is that you will gain an extended suite of supports so that you can focus more on patient care and less on administration.  At the same time, as with any major change lies some uncertainty. If you are thinking about joining an OHT, consider the implications on: new or shared accountabilities; what risk and gain sharing will mean for you; changes to practice autonomy; governance responsibilities; and contract management. See Q8 below for some of the questions you might consider before committing.

  • Effective change: These reforms present important leadership opportunities for family doctors, in terms of helping to shape the structure, governance and goals of an OHT, and supporting change among peers. And while research shows that family physician leadership in co-design and implementation results in better outcomes, it also needs to be enabled – this is not work that is easily done off the side of a desk. Family doctors should be driving this change equipped with proper guidance and leadership support. See Q11 for more details on the OCFP’s view regarding family physician leadership.

When should I join an OHT?

Changing the way care is delivered in Ontario will take time, and the level of readiness for change will vary among system partners – and that includes family doctors. Some family doctors already have built-in connections through structures such as Family Health Teams, Health Links, primary care networks and rural communities (Northern Health Hub), while others have less developed connections.

As such, you may wish to help lead the establishment of an OHT, or may be approached to become part of one, or choose not to participate for the time being. Currently, participation in an OHT is voluntary and depends on interest. As noted, if you are not part of the first call for self-assessments, you will have further opportunities to do so over the coming years.


Can I join regardless of my practice model?

Yes. As outlined in the Ministry’s Guidance Document, the criteria for an OHT are not tied to any particular type of practice model. Below are some scenarios for joining an OHT, depending on your practice context.

If you already have connections across settings and with other providers and are ready to engage:

  • You may be a family doctor already functioning with your local 'team' and already know who your local family physician and primary care leadership might be in a potential OHT. Family doctors who are part of groups of providers and organizations considering submitting a self-assessment can email our colleagues at the OMA at [email protected] or the Section on General and Family Practice at [email protected] to receive support in making their decision. If you are part of or want to connect with a Family Health Team, you can also reach out to the Association of Family Health Teams of Ontario at [email protected].

If you are approached to join or considering joining an OHT:

  • You may be asked to join a collaboration already underway or may look to initiate one with other providers. Some questions you might want to consider before committing are the following:
    • Do I have pre-existing relationships with partners in other settings/sectors that can form the basis of an OHT?
    • Am I on the same page as the other partners and do we share a common vision?
    • Are roles and responsibilities of all partners currently clear, and what will each contribute? Or will these roles and responsibilities still need to be defined, and will I have an opportunity to participate in scoping those definitions?
    • Is there already a governance model for the OHT and is there a family physician leader at the governance table? If there is not already a governance model, will I have an opportunity to help scope the model to ensure there are family physicians at the governance table?
    • How will family physicians participate in ongoing implementation? How will I be part of clinical decision-making in the OHT, not just in the set up but as it rolls out?
    • If I choose not to voluntarily participate, does that mean my patients may not be able to access OHT resources?
    • What does success look like for each partner and what are the measures of a successful collaboration in terms of outcomes?
    • Will my time be compensated given most others around the planning table are salaried and I am not?

What if I’m not sure about being involved right now?

We are aware that many of you are not involved in any group governance and that you may wish to “wait and see”.  We encourage you to keep apprised of what is happening in your community and to connect with other family physician leaders who may be participating.  We can help connect you if you are not certain. 


What are the timelines for OHT rollout?

Given the scope and scale of changes, a phased approach is expected over the next several years. Key dates for the first wave of OHT applicants are noted below.

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What is the OCFP’s role?

The OCFP’s submission on Bill 74 reinforced the importance of, and opportunity for, family physician leadership in driving change. We will also continue to advocate for the importance of OHTs to be anchored in primary care, with family physician leadership. We will be working closely with the Ministry, as well as our partners in primary care such as the OMA, Section on General and Family Practice, the Association of Family Health Teams of Ontario, the Council of Ontario Faculties of Medicine: Family Medicine Chairs, and others to ensure family physician leadership is supported to best enable reforms. With support, family doctors can lead the winning conditions to foster seamless care within an OHT, help peers through change, and take on roles in OHT governance.  


How do I learn more?
Regardless of your practice model and context, we anticipate that you may have questions as this health transformation unfolds. Speak to other family physician leaders in your community about some of the activity already underway or email us at [email protected]. If we do not have an answer to your question right away, we will reach out to the Ministry to try and get it.

You can also email the OMA at [email protected] or the Section on General and Family Practice at [email protected]  to receive additional support in your decision making. As well, if you are part of or want to connect with a Family Health Team, you can email the Association of Family Health Teams of Ontario at [email protected] with your questions about the reforms ahead.

You can also contact the Ministry directly as follows:

  • Email [email protected] for any questions related to OHTs and the application process, including self-assessments.
  • Sign up to receive the Ministry’s Connected Care Updates, including information about upcoming webinars.

The Ministry has provided the following list of resources as background on the OHT process:

Let us know what you think

The OCFP is committed to supporting you through this change, wherever you are within this process. We will continue to keep you updated and invite you to share your input and the support you need from us.

Have ideas or questions? Email us at [email protected].