The centrepiece of the Ford government’s health reform will be rolled out this fall when the first Ontario Health Teams (OHT’s) are designated. Currently the government is doing final reviews on 31 teams prior to designation. However, several unanswered questionsabout OHT operations suggest this initiative may be designed for failure.
OHT’s are voluntary collaborations between providers of hospital services, primary care, and community health services. In their applications for designation as OHT’s, the potential teams must describe how they will integrate services for a regional population and how they will ensure “warm handovers” for patients making transitions in the system.
The teams have responded to a “low rules environment” in these applications. Teams describe how they will govern their service planning, describe how they will integrate care for patients and how they will measure success without clear expectations from the ministry.
The lack of clear direction suggests that the ministry plans to review concepts from providers across the province to develop policy around provincial health care reform.
Given the lack of resources for planning OHT’s, it was expected that most teams would be led by hospitals since they have the largest budgets within potential OHT partners. Indeed, 23 of the 31 teams proceeding to OHT designation are led by hospitals.
With the opportunity to realign budgets for provider organizations within a region, will hospitals be able to resist the temptation to consolidate regional budgets to gradually provide better hospital funding? After all, Ontario hospitals have faced constrained budgets for years now.
The ministry has left it to the teams to describe how OHT’s will plan and decide on regional service delivery. There is no requirement for community or patient/family engagement in service planning. The governance of planning and resource allocation is left up to the OHT.
Since three quarters of OHT’s are hospital led, it is likely that hospital governance will dominate the health teams. Rather than community integration led by public demand for services in mental health or community care, OHT’s seem at risk for becoming hospital-driven organizations, where the strength of the hospital board governs decisions in the region.
Ontario hospitals are generally well governed entities and some would suggest that extending hospital governance to all other providers would be a step forward. This was probably not the expectation of the community groups collaborating with hospitals in Ontario Health Team planning, however.
A second major problem is that there is no clarity around the management of more than $4 billion of home-care services under an OHT. In a hospital-based system, hospitals and local home-care providers may easily collaborate in providing post discharge home-care. However, 85 per cent of home-care visits are provided to patients referred directly from the community with no hospital involvement.
The last government reformed home-care at the provincial level — raising PSW wages, standardizing levels of care for similar clinical situations as well as standardizing payments across the province. It is unclear what the ministry expects the health teams to do in leading home-care. Will we go from a standardized provincial approach to a system where each team creates its own home-care system? That seems like a very retrogressive step.
Finally, the teams have been told that budgets for the providers in the teams will be consolidated to allow shifting of resources as determined by the OHT governance process. Since primary care physician groups are providers within the OHT, this suggests that physician compensation should be part of the OHT budget. This would need to be negotiated with the Ontario Medical Association and a pathway to consolidation of physician budgets is difficult to contemplate.
In summary, the low rules approach to introducing Ontario Health Teams suggests care will be delivered through 50 to 70 hospital-led organizations, where decisions may be heavily influenced by local hospital boards, where consistent standardized provincial approaches to home-care could be abandoned for diverse local approaches and physicians keep their budgets out of the OHT while participating in leadership.
Given the lack of clear direction coming from the ministry, OHT’s seem at risk of creating a fragmented, chaotic approach to provincial health service planning. There are obvious advantages of scale evident in planning health services for 14 million people. At this point, the OHT process of planning at the local level without strong provincial guidelines may seem suspect.
Recent Comments