Performance Contract and Allocation Overview

1

• Performance Contract and Allocation Overview

2
What LHINs Do
IHSP Setting the Course
Community Engagement
Patient Centred Integration Service
Coordination

Local Health System Planning
Funding Allocation
3
What does this look like?

• What has changed as of April 01, 2007?
• Accountability
• Tool kit

Performance Monitoring
Accountability Agreements Executing the Course
Accountability Allocation
4
Video clip
Video Clip
5
What changed as of April 1?

• World on April 2 was much the same as it was on
  March 31, 2007
• Transformation will be evolutionary not
  revolutionary
• Health Service providers will want to prepare
  for
• An increased emphasis on accountability
• A focus on integration improved service
  coordination
• new approaches to everything from funding to
  health system planning

6
5 main areas where changes will be felt

• Increased integration and improved service
  coordination
• Increased local decision-making about funding and
  allocation
• Greater emphasis on local health system planning
• Increased community engagement
• Enhanced Accountability

7
1. Increased integration improved service
coordination

• After April 01, health service providers will
• Be responsible for aligning their service
  planning within the CE LHIN IHSP
• Implement the directions for integration laid out
  in the accountability agreements with CE LHIN
• Demonstrate continuous improvement in service
  integration coordination (LHIN will help
  facilitate shared best practices through our Comm
  Engagement structures)
• Take part in agreements and initiatives designed
  to further provincial objectives in areas such as
  access, quality, safety and efficiency

8
2. Increased local decision-making about funding
allocation

• CE LHIN will
• Assess priorities at local level
• Determine service configuration based on
  priorities
• Allocate funds accordingly
• Monitor fiscal performance contribution of
  providers to ensure integration system
  sustainability

• Health Service Providers will
• Submit business and service plans as required by
  their accountability agreements (same tools for
  now)
• Be responsible to CE LHIN for delivering programs
  and services on budget

9
Integration Initiatives/Ideas/Proposals

• Was it vetted by your Planning Partners?
• Is it aligned with the IHSP?
• Is it evidence-based and can it be measured
  monitored? (ie., Decision Support Performance
  Monitoring)
• Who shares accountability for its accomplishment?
  (ie., agreements funding)
• How will it be resourced?

10
3. Greater emphasis on local health system
planning

• CE LHIN will
• Identify and determine local health care
  priorities
• IHSP to reflect local priorities link with
  provincial strategic directions

• Health Service Providers will
• Continue to participate in CE LHIN Planning
  exercises
• Align strategic plans with those of CE LHIN
• Provide input and info necessary for CE LHIN
  Plans

11
5. Greater Accountability

• People have the right to expect accountability
  from their governments
• To that end, CE LHIN has entered into an
  accountability agreement with MoHLTC
• Patients have the right to expect that their
  health service providers will be accountable for
  the quality of services they provide
• To that end, part of CE LHIN mandate is to
  negotiate Service Accountability Agreements
  (SAAs) with health service providers

12
Accountability Framework

• STEWARD MANAGER
  PROVIDER

. . . .
13
Ministry of Health Long-Term Care the Central
East LHIN

• Accountability Agreement
• 2007-2010

14
Primary Agreement

• Purpose
• Supports the collaborative relationship between
  the MOHLTC and LHIN to carry out the made in
  Ontario solution to improve the health of
  Ontarians
• To set out the mutual understandings between the
  MOHLTC and the LHIN of their respective
  performance obligations in the period from April
  1, 2007 to March 31, 2010
• The Primary Agreement was previously reviewed and
  approved in principal in November 2006

15
Agreement Components

• Primary Agreement
• Schedule 1 General
• Schedule 2 Community Engagement, Planning and
  Integration
• Schedule 3 Local Health System Management
• Schedule 4 Information Management Supports
• Schedule 5 Financial Management
• Schedule 6 Financial Processing Protocols
• Schedule 7 Local Health System Compliance
  Protocols
• Schedule 8 Integrated Reporting
• Schedule 9 Allocations
• Schedule 10 Local Health System Performance

16
Where are we at?

• Building Blocks for YEAR 1

17
Times have changedEnvironmental Scanning is
secondary to community engagement, it quantifies
what we heard.
What We Heard (Engagement)
What we Found (Environment Scan)
What We Will Do (Our Plan)

• Number of seniors in CE LHIN and its Planning
  Zones
• Population Growth of Seniors
• Estimate of dementia cases in seniors

1.1 Improve access to LTC home services

• Priority 1
• Seamless care for Seniors

1.2 Enhance coordination of services
Seniors
1.3 Reviewing and building specialized geriatric
services
Our mantra Heard, Found, Do
18
We Own This Now!
KNOWLEDGE How agency provides service, other
similar services, total units of service in an
area related to population.
Very limited use of data to inform operations and
planning.
INFORMATION Profile of agency, type of service,
location, number of clients
DATA Raw counts of units of service, or total
expenditures. Databases.
19

• Environmental Scan OverviewOur Population
• The CE LHIN geography stretches from the
  culturally diverse and densely populated
  Scarborough planning zones to the rural and less
  populated areas of Haliburton Highlands, and
  northern sections of the City of Kawartha Lakes
  and Peterborough Counties.
• The population is mainly concentrated in the
  South West area of the LHIN, with almost 50 of
  the population in Scarborough.
• The area is characterized by rapid population
  growth for certain age groups and the second
  highest percent of those over 65 in the province.
  The 85 age group will increase by over 91
  between 2001 and 2016, and the 14-17 age group
  will decrease by 0.5 for the same period.

20
Example Historical Wait-time TrendingDiagnostic
Imaging - CT Scan
21
How we Approach Performance
March 2008 Estimated WT for MRI 115
It takes people to bend this curve
22
Example of Health System Goal Managed by LHINs
10.10
Strategy Map
9.10
9.75
9.62
8.79
9.20
Improve patient-centredness, integration and
quality of health services
Health System Scorecard

• Performance measure Score
• Total number of days percentage alternative level
  of care (ALC) 9.3

2003-0 4
2002-0 3
2001-0 2
2000-0 1
1999- 00
1998- 99
MLAA -negotiation
MLAA -negotiation
MLAA -negotiation
Average across Ontario
LHIN (1) Scorecard
LHIN (2) Scorecard
LHIN (3) Scorecard
11.04

• Performance measure
• Total number of days ALC
• Target

Score7.72 7.72

• Performance measure
• Total number of days ALC
• Target

Score 10.30 8

• Performance measure
• Total number of days ALC
• Target

Score11.04 9
10.30
5.27
LHIN 1
LHIN 2
LHIN 3
Average across LHIN (2)
LHIN (2) negotiates service agreements with its
hospitals on an individual basis regarding
strategies for managing alternative level of care
patients e.g. conducting a daily utilization
review to determine appropriateness of admission
and readiness of discharge developing closer
relationships with community agencies, etc.
12.09
10.55
Hospital (A) Report
Hospital (B) Report
Hospital (C) Report
3.85

• Performance measure
• Total number of days ALC

Score10.55

• Performance measure
• Total number of days ALC

Score3.85

• Performance measure
• Total number of days ALC

Score12.09
Hosp A
Hosp B
Hosp C
23
The Toolkit Accountability Agreements

• HSP Service Agreements
• HAPS/HAA
• Funding Proposals
• Capital/PCOP
• Risk Management

24
The Toolkit Population-based Funding

• Funding Letters
• - Summer 2007
• In-Year Pressures
• - Late Summer 2007
• Transfer Payment Allocation Management

25
A pessimist sees the difficulty in every
opportunity an optimist sees the opportunity in
every difficulty. - Sir Winston Churchill
26
Discussion And Questions