On April 3, 2019, the Ontario Government released detailed guidance documents to health care providers interested in becoming an Ontario Health Team (OHT). OHTs are a core component of the government’s efforts to improve the province’s health system performance, and were announced by Christine Elliott, Minister of Health and Long-term Care, at the end of February.
The guidance documents released today focus on achieving three goals. First, they describe the objectives and requirements of the OHT model and outline the application and selection process for OHTs. Second, the documents establish the expectations for OHTs when they reach maturity. Finally, they provide a self-assessment tool for groups of providers who are interested in applying to become an OHT.
The Ministry documents confirm that the OHT adoption process will be an iterative process with continuous intake of applicants. Early adopters are expected to be in place as early as this Fall.
The longer-term goal is for all Ministry-funded health care service providers to eventually become part of an OHT over the next few years. At the same time, the Ministry acknowledges that organizations across the province are at different states of readiness and many providers will require time and focused support to reach a sufficient level of readiness to become part of a team.
The Ministry also stressed that tailored incentives in the form of funding and other supports will be available to providers who engage in this process.
What is an OHT?
The Ministry defines an OHT as a group of providers and organizations that are clinically and fiscally accountable for delivering a full and coordinated continuum of care to a defined geographic population. The intent of the Ontario Health Team model is to allow providers to deliver better, faster, more coordinated and patient-centred care. The overall goal is for patients to receive all their care from one team – including primary care, hospital services, mental health and addictions services, long-term care and home and community care.
Under this model, providers are expected to leverage existing strengths and partnerships and work together towards common goals related to improved health outcomes, patient and provider experience. The model will fundamentally redesign relationships and accountabilities in the sector, and provide incentives for OHTs to scale, and spread quickly.
The Path to Becoming an OHT
The path to becoming a designated Ontario Health Team consists of four steps:
- Self-Assessing Readiness
Interested groups of providers and organizations assess their readiness and begin working to meet key readiness criteria for implementation.
- Validating Provider Readiness
Based on Self-Assessments, groups of providers are identified as being “In Discovery” or “In Development” stages of readiness.
- Becoming an Ontario Health Team Candidate
Groups of providers that demonstrate, through an invitational, full application, that they meet key readiness criteria are selected to begin implementation of the Ontario Health Team model.
- Becoming a Designated Ontario Health Team
Ontario Health Team Candidates that are ready to receive an integrated funding envelope and enter into an Ontario Health Team accountability agreement with the funder can be designated as an Ontario Health Team.
The Readiness Assessment
The readiness assessment process requires interested groups to complete a self-assessment using a Ministry-provided tool. The Ministry will evaluate responses and stratify groups into three levels of readiness:
- Applicants who are ready to proceed to a formal OHT application.
- Those who are “In Development” to becoming an OHT, and may require some modest additional work.
- Providers that are “In Discovery” and will require further assistance to achieve full readiness for implementation.
The Ministry notes that groups deemed to be ready to apply for OHT status and those groups who are ‘In Development’ may be able to access targeted funding in the future. The wording suggests that the Ministry could choose to direct net-new health system funding through the OHT model.
Although organizations who are deemed to be “In Discovery” (or those who don’t apply at all), are not identified as being eligible for new funding, the Ministry notes that an array of supports will be available to all interested organizations to assist them at each stage of their journey in order to reach Ontario Health Team maturity.
Available resources to all providers who come forward as part of this process will include:
- Tools and templates
- Data and analytics
- Digital health supports
- Support to grow and share best practices
- Change management support
- Legislative, regulatory, and policy or other enablers
What will an OHT look like at maturity?
The Ministry states that at its mature state, each Ontario Health Team will:
- Provide a full and coordinated continuum of care for a defined population within a geographic region.
- Offer patients 24/7 access to coordination of care and system navigation services and work to ensure patients experience seamless transitions throughout their care journey.
- Improve performance across a range of outcomes linked to the ‘Quadruple Aim’: better patient and population health outcomes; better patient, family and caregiver experience; better provider experience; and better value.
- Be measured and reported against a standardized performance framework aligned to the Quadruple Aim.
- Operate within a single, clear accountability framework.
- Be funded through an integrated funding envelope.
- Reinvest into front line care.
- Take a digital first approach, in alignment with provincial digital health policies and standards, including the provision of digital choices for patients to access care and health information and the use of digital tools to communicate and share information among providers.
The first OHTs will be monitored and evaluated by a third-party to generate learnings that will enable and guide other groups on the path to becoming an OHT.
The Ministry notes that the process to establish and support the development of Ontario Health Teams will contribute to the identification of further policy, regulatory and legislative reforms. The Ministry committs to minimizing barriers for the early adopters and those that come after.
Other highlights from the documents
- Services that are highly specialized such as transplant and neurosurgery will continue to be delivered by existing specialized providers and will be provincially coordinated. OHTs will work with the specialized service providers so that patients can access the specialized services in a timely fashion and be supported to transition back to their local OHT.
- Ontario Health Teams will be responsible for meeting all health care needs of a specified population within a geographic area that is defined based on local factors and how patients typically access care.
- At maturity, the size of each Ontario Health Team’s population will be sufficient to fully optimize clinical and financial outcomes and will account for unique regional variations and the needs across our rural, urban, and northern communities.
- OHTs must demonstrate that they respect the role of Indigenous Peoples and Francophones in the planning, design, delivery and evaluation of services for these communities.
- Physician participation is voluntary, however the Ministry acknowledges that their participation is key to the success of the model and invites them to play a leadership role and function as core members of the OHTs. According to the Ministry, successful OHTs can be built on existing physician remuneration models.