On Tuesday, February 28, 2019, Christine Elliott, Deputy Premier and Minister of Health and Long-Term Care, introduced a long-rumoured plan to reform the delivery of health care in Ontario. If passed, the proposed “People’s Health Care Act” will lead to significant changes in how the provincial health care system is structured, funded, and managed.
The reforms – a draft of which was leaked to the media on January 31 – center on two significant changes to the structure of Ontario’s health care system.
I. Launching Ontario Health Teams to Better Coordinate and Integrate Care
Newly dubbed “Ontario Health Teams” will be the new model of integrated and coordinated care delivery designed to help empower health care professionals to deliver more seamless care to patients as they access multiple health services – from primary care, to hospital care, to home and community care, to long-term care.
The Ontario Health Teams will provide service to either a defined patient population or a local region, a mandate intended to help them better respond to the needs and challenges of specific communities of patients, families and caregivers. Teams will also be “funded and held accountable” for improving patient outcomes and experience, which opens the door to performance models which could include elements of both risk-sharing and gain-sharing.
The identification and selection of Ontario Health Teams will proceed in phases, with further details to be announced in March. We expect the Ministry to begin the roll-out by announcing a number of Ontario Health Teams anchored to institutions that already deliver two or more different
types of health services (e.g. hospital services, primary care, mental health, home care, long-term care home services, etc.) in an integrated and coordinated manner. Meanwhile, the Ministry has announced a readiness assessment process to help interested groups apply to become an Ontario
II. Creating Ontario Health to Capture Operational Efficiencies
The government is also proposing to consolidate multiple Ministry-funded agencies and programs into a single, integrated agency called ‘Ontario Health’. The groups affected include Cancer Care Ontario, Health Quality Ontario, eHealth Ontario, HealthForce Ontario and the Trillium Gift of Life Network – as well as the province’s 14 Local Health Integration Networks (LHINs).
The creation of Ontario Health reflects the government’s belief that the Ontario health system, as it is currently designed, is fragmented, siloed, unwieldy and expensive. Consolidating multiple agencies with dedicated management teams and separate back-office functions is intended not only to capture administrative efficiencies, but also ensure that the delivery of care happens in a more consistent, coordinated, and effective manner.
More specifically, Ontario Health will have broad oversight of system coordination; clinical standards development for patient care and quality standards for patient safety; digital health, information technology, and data management services; recruitment and retention of health care
providers; and patient engagement. In a bid to streamline and simplify procurement, the Ministry is also establishing a single “province-wide supply chain management model” for the entire health care sector.
The process to create Ontario Health will take years to complete, due to the number of organizations involved and the need to ensure continuity of care and service delivery as the
integration process gets underway.
Insights and Implications for Stakeholders
1. The plan represents a significant overhaul of the provincial health system in two fundamental ways. First, most system planning functions will now be centralized and consolidated into Ontario Health. Second, accountability for delivering improved and integrated health services will be devolved to local institutions and partnerships.
2. Although the plan outlined this morning offers a blueprint for extensive system reform, many key implementation decisions have not yet been made.
3. We expect a prolonged period of disruption and internal focus by the staff in the Ministry of Health and Long-Term Care as various provincial agencies struggle to figure out who does
4. The reforms are a significant opportunity for health service providers who are willing and able
to secure the partnerships required, to deliver more integrated care delivery.