For Health Service Providers Feb 14, 2013 Updated April 04, 2013 Purpose
1) Share information about Health Links
2) Present Champlain’s process for becoming a Health Link
3) Describe how to get involved and provide input.
2 Technical Considerations
• Videoconferencing and Webcast
• Q & A instructions
3 Outline
1) Context & Background 4) Q & A
2) Recommended 5) Next Steps. Champlain Health Link Areas
3) Process & Timelines
4
1) Context & Background
Jan 2012 Dec 2012 Ontario Action Plan for • Health Links announced Health Care launched • www.champlainlhin.on.ca • Keeping Ontarians healthy • Ministry website coming soon. • Faster access and stronger link to family health care • Right Care, Right Time, Right Place
5 Alignment with Champlain LHIN Integrated Health Service Plan
Build a strong foundation of • Involvement in care primary, • Evidence-based care home and Health community • Seniors Link support • Mental health and addictions Improve • Complex chronic conditions transitions in • Palliative care care What is a Health Link?
7 Health Link Measurement Framework
1) Operational (Setting the Stage 3) Evaluation-Based for Coordinated Care) Metrics (How we will know • Coordinated Care plans for all we’ve arrived) complex patients • Enhance patient experience • Greater number of complex • Achieve ALC rate of 9% or less patients with regular and timely • Reduce average cost and keep access to primary care provider quality of care. 2) Six Results-based Metrics (Moving the Needle) • Reduce: time from PC to specialist, #30 day readmissions to hospital, # avoidable ED visits, time from referral to home care, unnecessary admissions to hospitals • Ensure PC follow-up within seven days of discharge from acute care setting 8 2) Recommended Champlain Health Link Areas
Why Divide Champlain into Health Link areas? • Ensure all people with • Minimize overlaps high needs in Champlain among Health Links to benefit from a Health avoid duplication and Link confusion • Ensure there is a critical • Reflect diversity across mass of people with high the region. needs covered by each Health Link
9 How Champlain Health Link Areas were Defined Areas should (criteria):
• Be home to at least • Have similar populations 50,000 people (with and health service use possible exceptions) patterns
• Be meaningful... • Have a sufficient mix and consistent with existing number of health service boundaries & how people providers, including live their lives primary care (ideally they (neighbourhoods, are already well- municipalities etc.) networked).
10 How Champlain Health Link Areas were Defined Applying the criteria: Staff studied data for 34 smaller ‘starter’ areas and combined them into 10 based on: • Adjacency • Critical mass (population, people with high needs, primary care and other providers) * • Population characteristics (distribution & demographics) • Which hospitals people tend to use * • Our understanding of local areas
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• Also: align with census and Ottawa Neighbourhood Study boundaries.
11 * = illustrated on subsequent slides ED Visits by Champlain Residents (2010-11)
We considered where people live and where they went Main Hospital: ED Visits By Champlain Residents (2010-11)
We looked at ‘main’ hospital
13 We considered # of people and distribution of providers Defining “People with High Needs” for Health Links
Those in the health Better: system who: • Access a) require care that is much • Quality more costly than the average; and • Outcomes We considered b) have needs that can be • Costs. definitions, rate better addressed through and numbers of improved coordination of people with high services across needs, etc. providers.
15 Some High-Needs Groups (Champlain residents 2011-12)
1) Had two+ acute care People with High Needs come in hospitalizations: 13,939 many shapes and sizes. • Had a readmission within 30 days: 8,961 No single data definition can capture the complexity. 2) Had a high cost* acute care hospital stay: 8,145 3) Made 5+ emergency department visits: 16,305
• Composite: met one or more criteria: 30,514 • Met all three criteria: 1,117
16 All data based on fiscal year 2011-12 only. *High cost defined to include those with acute inpatient stays in the top 10% by resource intensity weight (RIW), excluding, however, certain very high cost groups (e.g. transplants, premature babies, burns). People with missing postal codes are excluded from all counts. Overlaps of Groups with High Needs 2+ High Cost 5+ ED # Stays Stays Visits People No No Yes 12,542 No Yes No 3,826 No Yes Yes 207 People who had 2+ acute Yes No No 7,388 hospitalizations Yes No Yes 2,439 Yes Yes No 2,995 7,388 Yes Yes Yes 1,117 Any “Yes” 30,514
2,439 2,995 1,117 12,542 3,826 People who had 5+ ED People who had 207 visits high-cost acute hospitalizations
17 18 Data Reviewed for 34 Areas (partial data)
A: Ppl w/ B2: Ppl A: Ppl w/ B: Ppl B2: Ppl high cost B: Ppl w/2+ readmitte C: Ppl w/ high cost w/2+ readmitte C: Ppl w/ 34 Areas Analyzed Tot Pop High need IP stays acute IP d w/in 30 5+ ED High need IP stays acute IP d w/in 30 5+ ED (and grouped to 13) 2011 % 65+ group (R) (R) stays (R) days (R) visits (R) Main IP site Main ED site group (N) (N) stays (N) days (N) visits (N) Arnprior, McNab, Braeside 15485 19.0% 55.3 9.4 18.7 16.5 41.1 Arnprior Arnprior 857 146 289 255 637 Ba ys hore 35205 18.5% 26.0 8.9 13.9 10.9 11.3 QCH QCH 916 313 490 382 399 Beacon Hill, Rothwell Hts, Cardinal Hts, Car30115 20.1% 23.7 7.9 13.2 10.4 9.8 Montfort Montfort 715 239 398 314 294 Carleton Place and Beckwith 16780 14.4% 41.4 6.6 13.5 13.3 30.7 CarletonPl CarletonPl 695 110 227 224 515 Cedarview 46415 17.3% 23.5 7.8 12.9 10.3 9.9 QCH QCH 1092 364 601 477 459 Central Area 65365 14.0% 21.9 7.6 11.0 8.6 9.8 CivicTOH CivicTOH 1430 499 717 560 641 Clarence-Rockland 23165 11.8% 17.6 6.1 11.7 9.1 5.0 Montfort Montfort 408 141 270 211 115 Cornwall 46355 20.1% 53.5 11.2 22.6 20.8 34.7 Cornwall Cornwall 2482 518 1049 964 1608 Dundas 22020 18.1% 28.8 7.7 13.9 12.9 15.3 Winchester Winchester 634 170 306 284 336 Glebe, Old Ottawa South, Ottawa East 28415 12.9% 14.1 5.3 8.0 7.8 4.9 CivicTOH CivicTOH 402 150We 228 221 138 Glengarry 23435 19.8% 35.9 6.7 12.5 13.4 25.1 Cornwall Glengarry 841 156 294 315 588 Hawkesbury, E. Hawk, Champlain TWP 22445 21.0% 54.5 8.7 16.6 15.1 40.1 Hawkesbury Hawkesbury 1223considered196 372 340 899 Hunt Club, Leitrim, Riverside S. 76060 10.6% 15.6 4.9 8.9 7.1 5.7 GeneralTOH GeneralTOH 1190 375 676 538 436 Industrial East, Riverview, Pineview, Elmval 25845 16.0% 22.5 7.5 11.6 10.4 9.6 GeneralTOH GeneralTOH 581the rate193 and301 268 247 Kanata-Stittsville 92040 11.1% 14.1 4.4 7.9 6.3 5.6 QCH QCH 1298 401 726 581 517 Merivale 69980 15.6% 19.4 7.0 9.9 8.0 7.8 CivicTOH CivicTOH 1359numbers491 696of 558 549 Mississippi Mills & Lanark Highlands 17490 17.8% 22.0 3.3 7.5 7.4 15.3 Almonte Almonte 384 58 131 129 267 Nation, Alfred-Plantagenet, Casselman 24480 13.4% 17.0 3.7 7.6 6.2 9.0 Montfort Hawkesbury 416people91 with187 151 220 North Grenville 15080 13.7% 36.0 6.4 11.3 10.1 25.5 Kemptville Kemptville 543 97 170 153 384 North Renfrew Cty 54165 15.9% 53.9 9.3 21.2 21.3 36.9 Pembroke Pembroke 2917high505 needs,1147 1155 1999 Orleans and area 116565 9.9% 12.7 4.1 7.6 6.4 4.2 Montfort Montfort 1478 477etc. 882 748 488 Overbrook, Vanier, Beechwood 42785 15.6% 28.5 8.9 13.0 11.4 13.9 Montfort Montfort 1219 380 555 489 594 Playfair Park, Lynda Park, Guildwood Estates 22890 18.3% 20.0 7.7 10.7 9.3 7.3 GeneralTOH GeneralTOH 457 177 244 213 168 Rural Northeast 11685 12.2% 14.5 6.0 8.5 6.3 4.5 Montfort Montfort 170 70 99 74 53 Rural Northwest 23765 10.8% 37.1 8.4 15.0 14.2 22.8 QCH Arnprior 881 200 357 337 542 Rural Southeast 30175 10.8% 21.8 6.1 11.3 9.2 9.3 GeneralTOH Winchester 658 183 341 277 280 Rural Southwest 44870 10.7% 15.0 4.9 7.4 6.9 6.6 QCH QCH 674 222 331 310 295 Russell Twp 15250 9.2% 19.4 6.1 10.8 10.4 8.2 Montfort Winchester 296 93 164 158 125 South Central 22890 16.8% 17.6 7.3 8.8 9.0 6.6 GeneralTOH GeneralTOH 402 168 201 205 151 South Nepean 55605 7.3% 11.4 3.4 5.8 4.6 4.7 QCH QCH 635 190 325 255 259 South Renfrew Cty 31680 21.6% 43.7 7.6 13.8 13.3 32.4 Renfrew Renfrew 1385 241 436 421 1028 Stormont 19400 14.9% 25.7 6.3 12.1 12.6 14.3 Cornwall Cornwall 498 122 235 244 278 West Central 41595 17.9% 21.5 9.5 11.0 9.1 7.9 CivicTOH CivicTOH 896 395 457 378 328 19 34
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20 21 Champlain Recommended Health Link Areas 22
HLA # Description Prescott-Russell (excluding Clarence-Rockland and Russell Townships) and including Hawkesbury, Vankleek 1 Hill, Alfred, Limoges and Casselman. 2 The Counties of Glengarry and Stormont, as well as the city of Cornwall and Akwesasne. Russell Township including Embrun and Russell, as well as the rural southeastern portion of Ottawa (which 3 includes Metcalfe, Greely and Osgoode). The county of Dundas is also present and includes Winchester, Chesterville, Williamsburg, Morrisburg and Iroquois. Includes the Ottawa region of Beacon Hill, Rothwell Heights, Cardinal Heights, Carson, CFB Rockcliffe, Overbrooke, Vanier, and Beechwood. As well, it includes Orleans, Blackburn Hamlet, Cumberland, and the 4 rural north east Ottawa region (which includes Navan, Vars, and Sarsfield). The Clarence-Rockland region is also present (including Rockland, Wendover, Clarence Creek and Bourget). The Ottawa central Ottawa region including Nepean, Glebe, Old Ottawa South, Industrial East, Riverview, Playfair Park and Huntclub. It excludes Vanier and Overbrooke. The region is bounded by the Ottawa River to 5 the north , Conroy and Leitrim to the east, Earl Armstrong and Crestway to the south and Woodroffe to the west. Ottawa region including: Bayshore, Cedarview and South Nepean (Barrhaven). As well as the southwestern 6 portion of the city of Ottawa, including Manotick and North Gower, all the way down into North Grenville (including Kemptville). 7 The portion of Lanark County that is in Champlain. 8 Kanata, Stittsville and the rural northwestern part of Ottawa. Arnprior, McNab and Braeside are also South Renfrew County (exluding Arnprior, McNab and Braeside). Includes Renfrew, Golden Lake, Barry's Bay 9 and Quadeville. 10 North Renfrew County, including Deux Rivières, Petawawa and Cobden. 23 In Summary • We divided Champlain into • We also ensured each area 10 Health Link Areas to had a critical mass of ensure no one with high primary care and other needs is left behind providers. • To define the areas we considered: • Population characteristics, including the number and rate of people with high needs • Existing boundaries and “lived geographies” (including hospital use patterns)
24 Coming soon on our website to support you
• Profiles of each Health • Listing of providers in Link Area each area (LHIN-funded • Population characteristics and primary care) • High Needs counts and rates • Link to areas within • Overall health service use Google Maps. rates • Counts of providers in each sector (details to follow)
25 3) Process & Timelines
• Guiding Principles • Alignment with Primary Care work plan • Roles and Process • Timelines.
26 Guiding Principles
• Transparent • Collaborative process • Primary Care as the • Regional hospitals & foundation programs will support • One Health Link per and interact with all geographic area Health Links • Voluntary • Positions providers for success.
27 Alignment with Primary Care Work Plan
• Effective primary care • Going forward - is essential to a high- alignment of Primary performing system Care with each Health • Primary Care Physician Link. Lead • 2012/13 - Primary Care Networks started in Central Ottawa, Renfrew County. Specific projects focused on people with high needs
28 Process and Roles
29 Champlain LHIN First Steps
• Share information: Recommended geographies and relative profiles / provider lists, process, guiding principles, roles, known interested Engage with groups, Ministry resources potential Health • Facilitate discussions with potential Health Link group in each Link groups area: Interested groups are to ensure providers within your geography are aware of the group’s intent to propose a Readiness Assessment
• Receive and review readiness assessment, ensuring potential Health Links are: Review Readiness • positioned for success Assessments • aligned with Guiding Principles, Recommended Geographies (or proposed changes) and meets Ministry readiness assessment criteria
30 Interested Providers First Steps
• Talk to other providers in your geography Organize with Providers / • Complete (or revise, as appropriate) the Readiness Assessment Template* Networks If you need more information or support, contact the LHIN.
Submit Readiness • Submit your completed readiness assessment via email to Assessment the Champlain LHIN: [email protected].
31 * = available soon on www.champlain.on.ca So far, we have heard from:
• Arnprior and District Hospital • Madawaska Valley Circle of Care/Renfrew Victoria • CHEO Hospital • Connexion FHT and Hôpital • Perley / Rideau and Montfort South-East Ottawa Community • Cornwall Community Hospital Services and Seaway Valley • The Ottawa Hospital Community Health Centre • West Champlain Healthy • Hawkesbury & District Community Corporation General Hospital and (FHT) Lower Outaouais FHT • Winchester District Memorial • Kemptville District Hospital Hospital
32 Timeline
Webcast: Information & Rolling Resources: Champlain implementation Health Links www.champlainlhin.on.ca
33 4) Questions & Answers
34 5) Next Steps
• Opportunity for input: • More information: Do you see limitations regarding www.champlainlhin.on.ca the recommended geographic areas?
• Inquiries & completed readiness assessment to: [email protected]
35 36