Wednesday, November 30, 2022 – Ontario Health Minister Sylvia Jones led a webinar earlier today titled “Accelerating Ontario Health Team (OHT) Impact: Next Steps for OHTs” which included a number of key announcements related to the legal structure of OHTs and their priorities moving forward. The webinar was quickly followed by the release of a guidance document titled “Ontario Health Teams: The Path Forward”.
With this announcement, the government has laid out its roadmap for the next one to two years of OHT development. While implementation details and timelines are unclear, the government has clearly signaled a shift to greater standardization in how all OHTs will be structured and what they will be focused on in the near future. Specifically, the government communicated that the path forward for all OHTs will include the following five standard elements:
1. A common governance structure based on the establishment of a new not-for-profit corporation for each OHT
- This is an evolution away from “collaborative decision-making structures [that] have enabled OHTs to achieve consensus based goals”. The province will move to a “standard model that will support the future state vision of integrated clinical and fiscal accountability”.
2. Minimum expectations for member involvement in the OHT
The new minimum expectations will include the following:
- Primary Care Providers;
- Home and Community Care Providers;
- Community Care Providers;
- Public Hospitals;
- Mental Health and Addictions Providers;
- Patients, Families and Caregivers; and
- Physicians and other Clinicians.
- OHTs are encouraged (but have full discretion) to include other groups such as long-term care, municipalities, emergency health services, public health units, etc.
3. A requirement for each OHT to select an organization to provide shared back-office services for the OHT
- Each OHT will be expected to identify a single “Operational Support Provider” (OSP) to provide back-office services. It is expected that the OSP will be a member organization of the OHT.
- The Ministry of Health and Ontario Health will develop clear guidance and criteria to support the selection of an OSP for each OHT.
- The OSP will be expected to provide communications, project management, procurement support, etc.
- The OSP will not be allowed to have a disproportionate impact on overall OHT decision making.
4. A requirement for all OHTs to follow consistent public-facing communications protocols
- This includes guidance around consistent messaging, standards related to the use of social media, as well links back to government websites and resources.
5. Defined patient populations for the application of Integrated Clinical Pathways
- Although OHTs will be able to continue work on already-identified patient populations, all OHTs will also be asked to implement common integrated clinical pathways for priority population groups defined by the Ministry of Health and Ontario Health.
- The first area of clinical pathways focuses on chronic disease. Later pathways will focus on mental health and addictions and palliative care.
- The four priorities for chronic patient pathways are:
- Congestive Heart Failure;
- Diabetes, leading to limb amputation;
- Chronic obstructive pulmonary disease (COPD); and
- For all of the elements listed above, a number of specifics remain unclear. However, the province indicated their intent to follow-up in the near future with more specific guidance including implementation timelines.
Other Highlights from the Announcement
- Member organizations of OHTs would maintain their current accountabilities, with the new OHT non-profit entity acting as a coordinating umbrella over the existing local players.
- The pace of implementing the new OHT guidance will be impacted by local circumstances and health system capacity. Implementation details will be communicated to OHTs at a later date.
- The Ministry of Health and Ontario Health will provide further guidance about the supports that will be available to OHTs. Engagement with OHTs to inform further guidance and supports will begin shortly.
What Was Missing from the Announcement
Today’s announcement represents a major step for the OHT model and provides further clarity around certain aspects of OHT development. While some questions were answered, a number of missing items in today’s announcement would have provided further clarity to the sector about what the longer-term vision for OHTs will be in the coming years.
- The speakers repeatedly emphasized the centrality of primary care, but did not clarify what the primary care approach for OHTs would be.
- The speakers re-affirmed the vision for home care to be integrated into the OHT model, but did not provide clarity about when this would happen or how.
- There were references to performance indicators and benchmarks, but these have not yet been defined.
- There was one brief mention of funding, but this was not elaborated upon.
- The speakers acknowledged that many specifics regarding the implementation of the OHT model remain unclear and emphasized that the OHT development process will be evolutionary in nature.
This announcement sends two fundamental messages:
- Despite delays in OHT development in many regions due to the pandemic, the government is signaling a clear intention to continue to advance the model. They have re-committed to OHTs as a vehicle for local health system integration.
- The government is moving away from a “fit-for-purpose” or “low rules” approach to OHTs to more standardization and direction regarding the expectations for OHT form and function.
Following today’s announcement, many questions remain unanswered. But today’s announcement was the first significant indication from the government about their new approach to advance OHT maturity and their vision for integrated care across the province.