Ontario moves towards integrated care systems “for the people”…

Who ever thought that would need to be a headline in 2019?

I have to admit to being truly excited for the prospect of real change in Ontario’s healthcare delivery system. In fact I don’t think I have ever seen such momentum and bold initiative as I am seeing today from Queen’s Park. Of course the “devil will be in the details”, but that said, there have been political stakes put in the ground, organisational changes made and new leaders installed.

I look at this and I think “what a unique opportunity to think carefully and redesign how we provide care in the most appropriate and cost-efficient setting”.

And, to put a positive spin on the tardiness, “what great prior experiences we have to learn from and build upon”. In this regard I refer to Ontario’s HealthLinks initiative from a few years ago, as well as Western Canada’s regionalisation (BC), rationalisation (SK, MB) and even centralisation (AB). To the south we have witnessed the highs and lows of the US Accountable Care Organisations. Further afield we have NHS modernisation, world leading innovation in the Nordics, patient record access in Australia, and technology advancements in New Zealand. These are but a few examples of the leading edge thinking that I do hope Ontario’s new regime will fully explore, assess and learn from.

Also, fortunately, other things have moved forward too, like the plethora of modern technology and to a degree information exchange. Suitably harnessed, these should prove to be major contributors to the success of Ontario Health and the Ontario Health Teams.

Let’s deconstruct what can and should make up the critical elements of an integrated care system.

At its core, the system must be about better health outcomes for less money spent. From a pure economic point of view this can be viewed as increasing the value derived from our taxpayer dollar. All good and noble. So, what will it take to be successful?

  1. There must be effective transitions of care (warm handoffs) as patients move between the silos of health service delivery organisations.
  2. Incentives (bundled payments) must be in place that encourage the provision of services in the least costly setting.
  3. Patients must feel they are in control of their care journey;
    that they know what to expect, and when; and they are involved participants.
  4. Providers must work together in virtual teams, having ready access to accurate, complete and timely information about the patients they are seeing.

While I could talk about many critical elements that must underlie this fundamental shift, I will focus on two enablers that are at the core of it all: information availability and digital tools. Fortunately much has improved on both these fronts in recent times.

We have tools such as ConnectingOntario to share information among care providers. We are seeing shared clinical systems among neighbouring hospitals, such as Markham and Southlake, that provide instant access to diagnostics from one facility to the care team in the other. We are seeing patient access to records, such as MyChart from Sunnybrook, being expanding across southern Ontario.

We are seeing prototype programmes such as Southlake@Home which is tackling the dual problems of patients waiting too long for homecare services and the increasing occupation of acute care beds by ALC patients. This particular example is unique in that it is a true population-based initiative initially targeted at the frail elderly, rather than a traditional approach of focusing on patients within a specific disease group, such as heart failure. By building partnerships with primary care providers and local community homecare agencies, the programme is already seeing a significant reduction in ALC days per patient.

In this example, and indeed many other bundled-care funded initiatives, the providers are free to employ any combination of digital tools they wish. These can include virtual care, portal data access, online appointment booking and messaging, etc., all of which are readily available from several innovative companies today.

Couple these with care coordination tools and design thinking (more on that in my next article) to ease transitions of care, and we have the makings of a patient-first mindset that will deliver more seamless care in a more cost and resource efficient manner.

I actually have no doubt that these bundled care pilot projects will be successful. What I wish for is that the innovations and best practices that result are standardised and scaled across the province. Only then will we be able to systemically more towards a truly integrated care system for Ontarians.

I’ll close with this. If in Ontario we indeed are “for the people”, then what the people want is integrated care.

Alexandre Ledru-Rollin, a French politician in the mid 1800s has been attributed with this: “There go the people. I must follow them, for I am their leader.”

So I say – let’s hurry and lead!