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2014-17 Multi-Sector Service Accountability Agreement (M-SAA) An Overview Presentation to Health Service Providers January 10, 2014.

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Presentation on theme: "2014-17 Multi-Sector Service Accountability Agreement (M-SAA) An Overview Presentation to Health Service Providers January 10, 2014."— Presentation transcript:

1 Multi-Sector Service Accountability Agreement (M-SAA) An Overview Presentation to Health Service Providers January 10, 2014

2  Development and Preparation of the M-SAA  Template Agreement Components  Schedules  Indicators  Next Steps  Questions M-SAA An Overview

3 A tool to bring all the various contractual agreements between community HSPs and the LHINs into one document Required under LHSIA and Ministry-LHIN Performance Agreement (MLPA) A vehicle to delineate accountabilities and performance expectations A mechanism to clarify that the HSP will be responsible for performance as well as planning and integration towards the development of a health system 3 What is an M-SAA? Core lever for HSP accountability and performance management

4 Consistent template agreement for all community sector HSPs developed through comprehensive consultation with HSP associations and member representatives (membership listed in Appendix 1) 4 Pan-LHIN Development, Local Execution Developing provincial templates for local execution Schedules for each sub- sector (CCAC, CHC, MH&A and CSS) developed through consultation with sub-sectors Individual LHINs negotiate performance indicator targets with each HSP in alignment with pan-LHIN guidelines

5 The M-SAA Advisory Committee is co-chaired by Louise Paquette and Scott McLeod and brings together senior executives from M-SAA sector associations, community HSPs and the LHINs to provide a central forum for enabling dialogue on provincial M-SAA issues The Committee is guided by the following principles: The process is undertaken with a spirit of trust and collaboration among the province’s community HSPs, sector associations and the LHINs. The M-SAA will align with provincial health system priorities and be consistent with MOHLTC policy, legislation and regulations. The M-SAA will strive to streamline processes, minimize administrative burden and provide clarity for HSPs where possible. Committee membership is shown below 5 M-SAA Development Principles Enabling close ongoing collaboration with the Community Sector

6 6 M-SAA Structure Comprehensive Consultation through Multiple Tables M-SAA INDICATOR SUPPORT: HEALTH SYSTEM INDICATOR INITIATIVE M-SAA LEGAL COUNSEL SUPPORT: LHIN LEGAL SERVICES BRANCH M-SAA SECRETARIAT SUPPORT: LHIN COLLABORATIVE LOCAL M-SAA IMPLEMENTATION: LHIN M-SAA LEADS

7 7 M-SAA Advisory Committee Membership SectorOrganizationIndividual, Title LHINNE LHINLouise Paquette, CEO LHINCW LHINScott McLeod, CEO LHINNE LHINKate Fyfe, Senior Director LHINCW LHINBrock Hovey, Senior Director LHINCW LHINNeil McIntosh, Director CHCAOHCAdrianna Tetley, Executive Director CHCDavenport Perth Neighbourhood CHC Kim Fraser, Executive Director CSSOCSADavid Hughes, Director, Membership Development CSSCANES Community CareGord Gunning, CEO

8 8 M-SAA Advisory Committee Membership continued SectorOrganizationIndividual, Title CMH&AAddictions & Mental Health Ontario David Kelly, Executive Director CMH&ACMHA OntarioCamille Quenneville, CEO CMH&ACMHA TorontoSteve Lurie, Executive Director CCACOACCACSharon Baker, COO CCACCE CCACDon Ford, CEO LTCOANHSSJeff Graham, Director, Public Policy LTCCity of TorontoReg Paul, General Manager, LTC Homes & Services LTCOLTCAPaula Neves, Director of Health Planning and Research LTCExtendicare Inc.Christina McKey, VP, Eastern Operations

9 M-SAA Advisory Committee  Established to provide advice to the LHIN CEOs and support for the completion of the M-SAA template agreement and schedules in alignment with provincial strategic directions. M-SAA Indicators Work Group  Established to support the M-SAA Advisory Committee. Based on direction from the LHIN CEOs, the Work Group is responsible for producing a series of documents and recommendations including a list of recommended M-SAA indicators, technical specifications, target setting guidelines and education materials. M-SAA Planning & Schedules Work Group  Established to support the M-SAA Advisory Committee. Based on direction from the LHIN CEOs, the Work Group is responsible for producing a series of documents and tools including M-SAA Schedules, CAPS forms and planning submission guide and educational documents. 9 LHIN/Sector Responsibilities Advisory Committee and Work Group Mandates

10 10 LHIN/HSP Accountability Relationship How do the various CAPS/M-SAA components fit together? Community Accountability Planning Submission (CAPS)  Multi-sector Service Accountability Agreement (M-SAA)  Quarterly Reports [Ontario Healthcare Report Standards (MIS)]  Remediation Negotiation, Implementation of Consequences PlanningCommitmentMeasurementAdjustment Negotiations/ConsultationsNegotiations

11 LHINs are responsible for: Training and supporting HSPs through the CAPS and M-SAA processes Negotiating performance targets within the context of a provincial framework Monitoring the achievement of specific performance goals under the M-SAA and ongoing performance management HSPs are responsible for: Ensuring governance and operations that support high quality care Promoting leading performance improvement approaches Providing access to high quality health services and coordinated health care in an effective and efficient manner Identifying integration opportunities and engaging the public and stakeholders in any planned service changes. 11 LHIN/Sector Responsibilities What are the responsibilities of the LHINs and the HSPs?

12  LHINs revised language in the M-SAA that required updating or would benefit from greater clarity as a draft M-SAA for sector feedback.  Three 3-hour M-SAA Advisory Committee meetings to review and discuss comments and suggestions on draft M-SAA.  175 sector comments received and individually addressed.  Committee endorsed M-SAA and Schedules on December 17,  Pan-LHIN commitment to reduce, align and enhance consistency of local indicators.  Committee will continued to meet throughout the life of the agreement to advance M-SAA related priority issues. 12 Process for Finalizing New M-SAA At a high level, how was the M-SAA developed and finalized?

13 13 M-SAA Content – Articles Article 1 Definitions & Interpretation Clarifies terminology used throughout the document. Article 2 Term and Nature of the Agreement Defines the term of the service accountability agreement as April 1, 2014 to March 31, Article 3 Provision of Services Describes how services will be provided in accordance with legislation, applicable policies, e- health/IT compliance and the terms of this agreement. Discusses subcontracting services and conflict of interest. Article 4 Funding Outlines conditions of funding, payment and provision limitations. Procurement and disposition of goods and services are also described. Article 5 Repayment and Recovery of Funding Defines circumstances under which funding may be adjusted and/or recovered

14 14 M-SAA Content - Articles continued Article 6 Planning & Integration Discusses multi-year planning CAPS requirements in alignment with LHIN IHSP and priorities. Article 7 Performance Discusses the need for ongoing performance improvement and the mitigating process in the event of performance factors (non-performance). Article 8 Reporting, Accounting and Review Describes the obligations of reporting and record maintenance, French language requirements, disclosure of information, transparency and reviews. Article 9 Acknowledgement of LHIN Support HSP publications are required to note LHIN support, be approved by the LHIN, and indicate views do not necessarily reflect those of the LHIN or Government. Article 10 Representations, Warranties and Covenants Confirms the HSP’s ability to enter into the agreement and carry out the funded services with the appropriate governance, personnel and documentation.

15 15 M-SAA Content - Articles continued Article 11 Limitation of Liability, Indemnity & Insurance Outlines the limitation of liability and indemnification for the LHINs and the required insurance provisions for the HSP. Article 12 Termination of Agreement Describes the parameters for termination of the agreement by the LHIN and by the HSP. Article 13 Notice Details how notices to a party must be provided. Article 14 Additional Provisions Identifies additional provisions to the agreement. Article 15 Entire Agreement Defines the agreement as constituting the entire agreement, superseding all prior agreements.

16 16 M-SAA Content - Schedules ScheduleTitleDescription ADescription of ServicesDescribes the services delivered by the HSP, client populations and geography served BService PlanDescribes the financial and statistical status of the HSP CReportsIdentifies, describes and sets due dates for HSP reporting DDirectives, Guidelines, PoliciesIdentifies applicable MOHLTC policies EPerformanceIdentifies indicators, standards and local performance requirements FTemplate for Project FundingTemplate used for funding special projects GDeclaration of ComplianceForm to be completed by the HSPs Board of Directors to declare that the HSP has complied with the terms of the Agreement

17 17 Summary of Main Changes - Schedules What are the key changes between current and new Schedules? SCHEDULEDIFFERENCECOMMENTS Schedule A None Schedule B Schedule B1 - Added row 2 (HBAM) and row 3 (QBP) planning targets along with their functional centres for use by CCAC’s Schedule C Revised dates revised to reflect appropriate reporting period. Updated to reflect that Supplementary Reporting (including AAH) - Quarterly Report and Annual Reconciliation Report (ARR) will be reported through SRI Self Reporting Initiative (SRI) has replaced the Web Enabled Reporting System (WERS) for reporting

18 18 Summary of Main Changes (continued) What are the key changes between current and new Schedules? SCHEDULEDIFFERENCECOMMENTS Schedule D Updated to reflect current directives, guidelines and policies Added Guideline for Community Health Service Providers Audits and Reviews, August 2012 Added note indicating that the Community Financial policy is currently under review Intended to LHINs in undertaking a transparent process in identifying and responding effectively and consistently to HSPs Review process includes MOHLTC, LHINS and community sector representatives Schedule E See update from Indicators Work Group

19 19 Summary of Main Changes (continued) What are the key changes between current and new Schedules? SCHEDULEDIFFERENCECOMMENTS Schedule F Updated to reflect HSP “services” rather than “deliverables” Schedule G Added Appendix 1 - Exceptions

20 – 17 M-SAA Indicators

21  Health System Indicator Initiative (HSII)  Schedule E Indicators  Performance Standards  Targets Setting  Indicator Work Group Focus and Approach  Summary of Indicators & Technical Specifications – Core Indicators – Community Health Centres (CHC) Indicators – Community Care Access Centres (CCAC) Indicators – Community Service Sector (CSS) Indicators – Mental Health & Addiction (MH&A) Indicators 21 Introducing the Indicators

22 In April 2010, the LHIN-led HSII was established to create a coordinated, system-based approach to indicator identification, development, maintenance and reporting. Central to the mandate of HSII is the close collaboration with provincial and national partners in order to leverage their organizational expertise related to indicator development, benchmarking, data extraction, and analysis. The revised mandate introduced in September 2013 provides a greater focus on alignment to system priorities, advancing system performance improvement through the SAAs and other mechanisms, and enabling monitoring and reporting. 22 Performance Indicators Health System Indicators Initiative (HSII)

23 The Performance Schedule (Schedule E) contains the following two indicator sections: 1. Pan-LHIN Indicators are developed through the M-SAA Indicators Work Group through HSII (core indicators are relevant to all LHINs and all community sector HSPs; sector-specific indicators are only relevant to a specified sector). Performance Indicators are measures of HSP performance for which a Performance Target is set; Technical specifications of specific Performance Indicators can be found in the “M-SAA Indicator Technical Specifications” document. Explanatory Indicators are measures of HSP performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the “M-SAA Indicator Technical Specifications” document. 2. LHIN-Specific Performance Obligations: A section where each LHIN adds specific performance objectives and obligations for their HSPs is included. LHINs are committed to minimizing any undue burden placed on providers with respect to performance management by focusing on a limited number of outcome indicators aligned with local priorities. 23 Performance Indicators (Schedule E) Pan-LHIN Performance Indicators and LHIN-Specific Obligations

24 All performance indicators have an associated target and standard of performance. Variance outside of the standard triggers the performance management processes in Article 7 of the M-SAA. The LHIN or the HSP can identify a Performance Factor that “…could or will significantly affect a party’s ability to fulfill its obligations under the Agreement.” The identification of a Performance Factor is made formally, in writing, to the other party and will include a description of the Factor’s actual or anticipated impact and a description of any action the party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor. 24 Performance Indicators Why Performance Standards?

25 Following the submission of the CAPS, LHINs and HSPs discuss indicator targets that are appropriate to each organization and its local circumstances. Targets are expected to reflect performance and drive continuous improvement. To complete the targets and corridors for the performance indicators, the following principles will be employed: Where provincial targets and corridors exist, the LHINs and HSPs will take these into consideration Where appropriate, use past experience from M-SAA and MLPA indicators Incorporate analyses of historical variation to inform corridor recommendations Use % range for financial and volume indicators 25 Performance Indicators Continued How are Indicator Targets and Corridors Determined?

26  How a LHIN chooses to deal with an indicator outside the corridor depends on a number of factors, including: What is the realized and/or potential impact on the clients served? Is this the first blip on an otherwise clean performance record? Is this a unique event and unlikely to recur? Are other areas of the organization or other HSPs affected? What is the LHINs confidence in the HSPs ability to manage performance going ahead?  Depending on the above, the LHIN could choose to start with a less formal tact. The formal process is always available...and can be triggered at any point. 26 Performance Management How are Performance Factors Addressed?

27  Review current indicators and develop recommendations to reduce the number of indicators  Develop recommendations regarding the definition and target setting approach for the administrative indicator calculation  Align existing indicators with pan-LHIN imperatives 27 Indicator Work Group Focus & Approach

28 Balanced budget - Fund type 2 Proportion of budget spent on administration Variance forecast to actual expenses Percentage total margin Service activity by functional centre Variance of forecasted to actual units of service Number of individuals served Percentage of Alternative Level of Care (ALC) days 28 Core (All Sectors) Performance Indicators

29 Cost per individual serviced by program/service/functional centre Cost per unit of service by functional centre Client experience (New Category) Details: – Moved from being only an explanatory indicator for the Mental Health and Addiction sector – Indicators Work Group identified need to enhance linkage with quality and patient experience for all sectors 29 Core (All Sectors) Explanatory Indicators

30 Access 1: 90 th Percentile Wait Time From Hospital Discharge to Service Initiation (Hospital Clients) Access 2: 90 th Percentile Wait time from Community Setting to Community Home Care Services * Percentage people registered with Health Care Connect who are referred (Retired) Details: – Reporting obligations are already in place with the Ministry 30 Community Care Access Centres Performance Indicators

31 Access: Wait time th Percentile wait time from hospital discharge to service initiation (hospital clients) by population groups (short stay, short stay rehab, long-stay complex) Access: Wait time th percentile wait time from Community setting to community home care services by population groups (short stay acute, short stay rehab, long-stay complex) Average monthly cost per episode (adult short stay, adult long-stay complex, end of life, children medically fragile) Clients with MAPLe scores high and very high living in the community supported by CCAC (New Category) Clients placed in LTCH with MAPLe scores high and very high as a proportion of total clients placed (New Category) 31 Community Care Access Centres Explanatory Indicators

32 Clients with MAPLe scores high and very high living in the community supported by CCAC Clients placed in LTCH with MAPLe scores high and very high as a proportion of total clients placed Details: – Moved from CCAC performance indicator category – Indicators fit this category and provide valuable information about how the system is functioning and the opportunities for change – Indicators are not a good measure for performance as targets are set locally by each LHIN 32 Community Care Access Centres New Explanatory Indicators

33 * Percentage of clients with a new or existing pressure ulcer that failed to improve (Retired) * Medication safety (Retired) * Percentage of home care clients who say they have fallen in the last 90 days (Retired) Details – Indicators retired as developmental – Indicators were not identified by HQO as on the Common Quality Agenda 33 Community Care Access Centres Developmental Indicators

34 Number of persons waiting for service (by functional centre) 34 Community Support Services Explanatory Indicator

35 Average number of days waited for first service (by functional centre) (New Category) Details: – Moved from CSS Explanatory indicator category as the data is not yet available – Move to explanatory in years 2 or 3 * Repeat unscheduled emergency visits within 30 days for mental health conditions (Retired) * Repeat unscheduled emergency visits within 30 days for substance abuse conditions (Retired) Details: – Indicators are difficult to measure - cannot follow clients between the hospital and the community 35 Community Support Services Developmental Indicators

36 36 Community Health Centres Performance Indicators Cervical cancer screening Colorectal Screening rate Inter-professional diabetes care rate Influenza vaccination rate Breast cancer screening rate Periodic health exam Vacancy Rate (for NPs and Physicians) Access to primary care clinical service (New) * Individuals served by functional centre (Retired) Details: – Already a Core indicator

37 37 Community Health Centres Explanatory Indicators Emergency visits best managed elsewhere (New) Client satisfaction – Access (New) Clinical support staff per primary care provider (New) Cultural interpretation (New) Exam rooms per primary care provider (New) New grads/new staff (New) Number of new patients (New) Non-Primary Care activities (New)

38 38 Community Health Centres Explanatory Indicators Cont’d Number of registered clients (New) Specialized care (New) Supervision of students (New) Third next available appointment (New) Non-insured clients (New) * Repeat unscheduled emergency visits within 30 days for mental health conditions (Retired) * Repeat unscheduled emergency visits within 30 days for substance abuse conditions (Retired) Details: – Data is a challenge as the cell size is small

39 39 Community Health Centres Developmental Indicator CHC clients hospitalized for Ambulatory Care sensitive conditions

40 40 Community Mental Health & Addiction Explanatory Indicators Number of days waited from referral/application to initial assessment complete Average number of days waited from initial assessment complete to service initiation Repeat unscheduled emergency visits within 30 days for mental health conditions (New Category) Repeat unscheduled emergency visits within 30 days for substance abuse conditions (New Category) Details: Moved to Explanatory indicator * Client experience (Retired) Details: Moved to Core indicator

41 OCAN/GAIN Indicator 41 Community Mental Health & Addiction Developmental Indicator

42 The LHINs are working collaboratively with their HSPs to finalize M-SAAs by March 31, Next Steps What are the work streams and key dates? CAPS Submitted to the LHIN No v 15 CAPS Reviewed and Adopted by the LHIN 75%complete Local M-SAA Orientation for HSPs Jan 10 CW LHIN Board to Approve M-SAA Template Jan 22 CW LHIN to prepare M-SAA Schedules Jan LHIN to meet with HSP's to negotiate performance expectations Jan 28Feb 14 LHINs to Prepare M-SAAs Feb 15–28 LHIN to distribute Final M-SAAs to HSPs Mar 5 HSP Board Approval of M-SAAs Mar 31 LHIN Board Approval of M-SAAs (by Mar 31) Mar 31 Post M-SAAs to Websites April 10 NovDecJanFebMarApr

43 43 Questions? Comments?

44 44 SectorOrganizationIndividual, Title LHINCW LHINBrock Hovey, Senior Director, Health System Performance LHINCW LHINNeil McIntosh, Director, Performance and Accountability LHINCH LHINPatrick Manhire, Senior Accountability Specialist LHINHNHB LHINJim Borysko, Advisor,Health System Performance LHINNE LHINKate Fyfe, Senior Director LHINSE LHINMike McClelland, Senior Financial Analyst LHINMH LHIHShehnaz Fakim, Senior Lead, Health System Performance Management APPENDIX 1: M-SAA Planning & Schedules Work Group Membership

45 45 APPENDIX 1: M-SAA Planning & Schedules Work Group Membership continued SectorOrganizationIndividual, Title LTCOLTCAPaula Neves, Director of Health Planning and Research LTCOANHSSJeffrey Graham, Director, Public Policy CCACSE CCACCarol Ravnaas, Sr. Director Strategic Partnerships & Accountability CSSOntario March of DimesJason Lye, Associate Director CHCBrock CHCRon Ballantyne, Executive Director CMHARiverside Community Counseling Services Jon Thompson, Director MOHLTC Vanita Bhandari, Manager, Data Standards Unit, Health Data Branch MOHLTC Christine Brown, Team Lead, Planning & Negotiations, LLB

46 46 APPENDIX 1: M-SAA Indicators Work Group Membership SectorOrganizationIndividual, Title LHINNE LHINKate Fyfe, Senior Director LHINNW LHINJames Anderson, Performance and Contract Management Consultant LHINMH LHINHeather Kundapur, Senior Lead, Health System Performance LHINTC LHINGreg Stevens, Senior Consultant, Performance Management LHINNWLHINKevin Holder, Senior Consultant, Funding & Performance LHINESC LHINPete Crvenkovski, Director, Performance Quality and Knowledge Management LHINHNHB LHINPhilip Christoff, Director, Quality & Risk Management LHINHNHB LHINRosalind Tarrant, Director, Access to Care

47 47 APPENDIX 1: M-SAA Indicators Work Group Membership continued SectorOrganizationIndividual, Title LHINHNHB LHIN Gaya Amirthavasar, Health Information Advisor LHINWW LHINTed Alexander, Manager, Contracts and Accountability CSSCheshire LondonAngela McMillan, Attendant Services Manager CSSOntario March of DimesLee Harding, Director, Independent Living Services CSSDale Brain Injury ServicesSue Hillis, Executive Director CCACTC CCACAnne Wojtak, Senior Director, Performance Management & Accountability CCACOACCACRod Millard, Director, Information Management CMHAReconnect Mental Health Services Mohamed Badsha, COO

48 48 APPENDIX 1: M-SAA Indicators Work Group Membership continued SectorOrganizationIndividual, Title CHCAOHCJennifer Rayner, Regional Decision Support Specialist LTCOLTCAPaula Neves, Director of Health Planning and Research LTCOANHSSDan Buchanan, Director of Financial Policy MOHLTC Naomi Kasman, Senior Health Analyst, Health Analytics Branch MOHLTC Soma Mondal, Manager, Health Analytics Branch


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