Commisioner Don Drummond raised it in his report. Former OHA President Tom Closson frequently spoke about it. Five per cent of the Ontario population uses up about 40 per cent of the provincial health budget each year at an average per patient cost of $44,500.
The thinking is, if we better understood these “high users,” could we streamline the local services they receive and save money in the process?
There is no question that Ontario’s health system is incredibly fragmented and surprisingly getting more so as hospitals are urged to further divest services. The Local Health Integration Networks have been given the difficult task of turning a mix of independent private for-profit, private not-for-profit and public entities into a coherent public system for patients.
That task is further complicated by various strategies that push and pull in various directions. There is a provincial health strategy (released last January), a three-year Local Integrated Health Service Plan (which the LHINs are now completing for 2013-15) and a considerable number of specific initiatives, including Ontario Health Links and as yet unreleased Seniors Strategy. At a recent Breakfast With The Chiefs, the term “project-itis” was bandied about to describe the difficulties front line providers faced with such ongoing and layered restructuring.
In the Central East LHIN they have been recently bringing together community health care providers in various local clusters to look at how they can better integrate services between them. Integrations in the LHIN world can include anything from simple coordination of services to outright transfers and closures. Everybody wants the former; the latter often sends parties to the mattresses. The LHINs don’t have the direct power to merge legal entities.
Now the province has slapped a catchy name to this latest integration process – calling it Ontario’s Health Links. They are telling the LHINs to bring the usual suspects together with primary care providers and hospitals to coordinate plans at the patient level. This is even though most primary care providers are not under the LHIN umbrella.
The word “initially” comes into play with these Health Links. “Initially” they will be voluntary. “Initially” they will look at high users. It’s not clear what happens after they get past this “initial” phase.
While voluntary, the Health Links will have “flexible” funding attached to them and be formalized to the extent they will be required to meet targets established under accountability agreements with the LHINs. There is no indication of how much of funding the province intends to bestow upon these entities, especially at a time of significant restraint.
The Ontario Health Links could include representation from Community Care Access Centres, long-term care homes, community service providers, specialists, primary care physicians, allied health professionals and hospitals.
The goal is to set up these organizations in sub-LHIN jurisdictions of at least 50,000 people and involve at least 65 per cent of local service providers. That doesn’t leave much room for health care providers not to “volunteer.”
A more detailed announcement on Ontario Health Links will be coming from the Ministry of Health soon.