Collective agreement limitations and compensation challenges in relation to our service integration strategies
There is significant compensation variation between LHIN Care Coordination and Primary Care nursing staff, which may present retention issues, struggles in team morale based on significant variations in pay of nurses working alongside one another, or more significant challenges related to union spread and wage harmonization.
There are provincial examples of “contracting out” and “contracting in” grievances and arbitrations that have arisen from service integration efforts, which could pose potential risks.
The team will take a well-informed, methodical and risk-managed approach to service integration strategies that make all efforts to mitigate and/or minimize these risks. Legislative changes will be required as integration enablers.
Considerable planning and change management support is required to realize the culture alignment, relationship and trust building, work-flow and role clarity etc. amongst the developing Integrated Primary Care Teams. We are fully aware of the imperative to ensure a strong culture is developed so as to not limit the success of this strategy. In our already LEAN system and organizations, the resources to support our culture development will have to be pulled from other areas.
From experience with similar integrated team models, our leadership has considerable expertise in these integral design and implementation requirements, though also fully understand the intense time and resource commitments that are necessary to support their success.
Telemedicine remains an uninsured service – this is a disincentive for physicians to adopt the desired practice change. A billing code for physician virtual visits and Expansion of existing OHIP billing codes (i.e. K738 and K739) to include clinician to patient eConsult will greatly improve the pool of physicians and patients who can benefit from this service.
Sustainable funding for digital health platforms that have been identified in Appendix B as being part of our plan to deliver integrated care to our population. For example:
- Funding to support the MyChart platform once the Canada Health Infoway funding expires and stable funding for Clinical Connect and IDS.
- SCA “Next Step” letters, eReferrals all require on-the-ground resources to enable the collection of email consents from primary care patients. We require existing infrastructure and the continued support of the eHealth Centre of Excellence QBIC team to support this work.
- Provincial funding is required to support the completion of the development of the Caseworks Access Portal. If that funding becomes available, we will explore how the Caseworks Access Portal can be leveraged to support patients with mental health and addictions needs, as well as other patient cohorts, by providing digital access to their health information.
Home and Community Care
Current service provider contracts are limiting both in terms of motivating quality outcomes and innovative service delivery models and managing performance. Maintaining contracted market share volumes will be a constraint as we work with the WWLHIN to reduce the number of service providers delivering care to the Guelph and Area attributed population.
The requirement that the InterRAI be used to enable and inform access to all in-home services is a challenge both related to the workload burden associated with the use of the tool and associated with the limitations it places on innovation in terms of integrating the functions of care coordination across roles on the IPCT. The perceived and real lack of flexibility in the type of RAI assessment completed (e.g., interRAI HC tied to funding) does not allow for flexibility in the full suite of tools that could support common assessment informed by multiple care team members leading to equitable access of service supporting patient outcomes both within the OHT and across the province. The G&A OHT looks forward to improvements to the user-friendliness and efficiency of interRAI implementation and application (including self-assessment and integration into EMR platforms etc.)
Primary Care Team
The ability of the WWLHIN to partner with the G&A OHT on tests of change with regard to H&CC roles, processes etc. cannot be done to the detriment of the other required functions or the other geographies (and the patients in them) that are not yet under an OHT. The LHIN’s commitment is to support incremental implementation in context of the broader system of H&CC as it evolves. This important constraint must be considered when developing timelines for this transformational change.
The integration of home care services into Ontario Health Teams requires certain elements to be implemented in a consistent fashion across OHTs in order to minimize confusion. In past reviews of the home care sector, the Office of the Auditor General has identified a need for increased consistency in the allocation and provision of service, with the goal to establish equity. As OHTs will be implemented in a staggered fashion across the province, there is likely to be a period of disruption and enhanced variability that could impact patient care negatively if not managed carefully. Where the Ministry intends to create consistency in the provision of home care services, or where legislation or policy will be evolved, it will be beneficial for OHT planning tables to be aware of the “rules of the game” where they exist, prior to progressing too far in the implementation process. Early communication of the parameters within which resources can transfer, and roles and functions can be evolved will enable the model design.
Current privacy legislation is a significant barrier to advancing a fully integrated care team model. We encourage the government to consider legislation changes related the definition of circle of care to be more inclusive.
Reword the “Circle of Care” direction. This would assist with opening up the chart and remove the need to have a data sharing agreement with all parties.
Health Human Resource (HHR) issues around recruitment for specific front line and community care positions will need to be continually monitored moving forward to ensure equitable service delivery can be maintained.
Facilitators RISE resources and WDG Public Health Analytics Team and interactive reports data have both been identified as facilitators of change. We will also engage with local champions of change within our partner organizations to help facilitate and leverage best practices that have not yet spread to the broader OHT area.