Ministry Plans

Results-based Plan Briefing Book 2013-2014


Ministry of Health and Long-Term Care Overview

Introduction

The release of the government's Action Plan for Health Care in January 2012 signalled a new way of thinking about the province's health care system. Over time, the system had become provider-centric and focused mostly on acute care delivered by excellent providers, but often working in individual silos.

It was clear the province had to look at how the various parts of the health care system could work better together so that people stayed healthier in the first place, family health care providers became the front door and navigators of the system and services were delivered by the right provider at the right time and in the right place.

At the same time, it was necessary to improve patient and client satisfaction through higher quality of care, better access to services and better value for investment.

The government has taken concrete steps to build a strong foundation of quality health care including significantly reducing wait times. But health care spending has been growing at an unsustainable rate. In 2012-13, 42 cents of each dollar Ontario citizens and businesses sent to the government was spent on health care. Unchecked, the government will spend 70 cents on health care a dozen years from now, leaving only 30 cents to be shared among all other public programs, including education.

A radical re-engineering of the system was called for, not simply change at the margins.

The province is shifting its health care priorities to protect its ability to pay for the health care services the people of Ontario rely on. There is a focus on increasing the value of each health care dollar and on improving the quality of patient care across the board.

With this shift, Ontario is improving the quality of patient care, freeing up valuable acute care resources for those who need it most and increasing the value for taxpayers. Higher quality care that is driven by evidence and delivered properly the first time is better for patients and better for taxpayers.

The ministry has made great progress on implementing the Action Plan over the past year. The system has to provide a seamless and efficient patient journey that makes the best use of resources in an integrated, coordinated way. And if the province is going to improve care and get better value for its health care investments, it must have a laser-like focus on those who need health care the most.

One-third of health spending is spent on just one per cent of Ontarians, while five per cent of patients account for two-thirds of our health care costs. These may be seniors with complex, multiple needs, people with mental health issues or those with chronic conditions. Seventy-five per cent of seniors with complex needs who are discharged from hospital receive care from six or more physicians in addition to home care, community services, pharmacists and a range of other health providers.

Frequently, the care seniors receive from all these providers is not coordinated, which leads to duplication or someone falling through the cracks. And all too often, gaps in care can result in preventable trips to hospital.

Even a 10 per cent reduction in the cost of care for these Ontarians would save about $2 billion, funds that could be reinvested in the system.

To begin to tackle these health care challenges, the ministry has decided to focus its initial efforts on these patients, because to do so will benefit the entire system.

To build a system that provides better, more immediate care for patients – yet is still one that is affordable for generations to come – requires a major transformation. Leading that transformation is the ministry's principal work over the coming year.

The ministry will redesign the health care system to put people at the centre of health care. It will ensure better coordination and collaboration across the system.

The transformation of the health care system will be driven by three main elements.

1.  Funding reform

Health System Funding Reform (HSFR) is an essential component of Ontario's health care system transformation. It will create a provincial funding model, which is both responsive to the emerging health care needs of the population and encourages the adoption of best practices. The link between funding and the delivery of care will encourage patient-centred care and a system focused on improved outcomes.

The main benefits of HSFR include:

  • Patient-centred care, which will focus on individuals and ensure funding follows the patient;
  • Smarter use of limited resources, which will drive a sustainable health care system based on quality.

There are two key components to HSFR:

Health Based Allocation Model (HBAM)
Funding is allocated to hospitals and Community Care Access Centres (CCACs) at the organizational level using HBAM.

Quality-Based Procedures (QBP)
Funding is allocated to specific procedures based on a "price X volume" approach. This involves providing evidence-based allocations to targeted clinical groups. The price is structured to provide an incentive and adequately reimburse providers for delivering high quality care.

By the end of 2013-14, hospitals budgets will consist of 49 per cent global or base funding, 40 per cent HBAM and 11 per cent QBPs.  The ministry is also expanding funding reform into the community sector, where HBAM will account for about 30 per cent of overall funding.

In the end state, HSFR will comprise 70 per cent of the funding envelope provided to hospitals with the remaining 30 per cent based on global funding.

Funding reform ensures that the patient is placed on a more standardized and coordinated health care path through their health care journey, since funding will follow the patient and not the provider. The model provides incentives to deliver the highest quality, most efficient care in the most appropriate channel of delivery.

2.  Strengthening integrated care

The government has committed to remove barriers to allow for partnerships among health care providers that support the creation of a seamless patient journey.

The ministry is working to ensure that the people of Ontario get the care they need, when and where they need it. For it to be true integration, all the partners in the system – the ministry, LHINs, CCACs, hospitals, health care professionals and community support agencies – need to be guided by a common understanding of what they jointly want to achieve.

The Excellent Care for All Act 2010 and strategy set the stage for integration and collaboration across the sector. Now, the ministry is taking it further with community Health Links.

By establishing community Health Links, the ministry is creating new ways for hospitals and primary care providers to work together in communities across Ontario at the clinical level.  Bringing together providers in local communities will ensure that patients are put at the centre of the system. Health Links will develop and execute coordinated care plans, starting with seniors and people with complex health conditions.

We know that spending is concentrated in a relatively small number of high users. One per cent of Ontarians account for one third of health spending and the top 5 per cent make up two-thirds.

There are now 23 Health Links in Ontario and it is expected that additional Health Links will come on board on a regular basis. Health Links will support better integration of care and more efficient and effective care. They will also be accountable for system‑level metrics focused on improving patient outcomes and ensuring better value for money.

The ministry will, in turn, create an overarching framework explaining what we want to see achieved. But ultimately, it will be up to health care providers to determine the how.

It is expected that patients will feel more satisfied with their experience and will receive faster access to care through their primary care provider (or family health teams), rather than a hospital emergency department. Providers will be accountable for quality across the entire patient journey, including how their patients move from one part of the system, for example from hospital to home care. Providers will work together more collaboratively at the ground level to better meet the needs of patients.

The system will experience efficiencies by being able to more effectively address the needs of those who use it most. At its maturity, if this model can provide a 10 per cent improvement in the care experience for these top 5 per cent of patients, it will result in $2-$3 billion in savings.

3.  Right Care, Right Time, Right Place

The ministry will maximize health care investments by shifting services into more appropriate and cost effective settings, ensuring that the services are provided at the right time and in the right place.

Based on evidence, the ministry will look to move appropriate procedures out of an acute care setting and into the community and leverage a competitive pricing model.

The same model applies to community care which would be used to support seniors who are transitioning back home after an acute episode in hospital. Evidence indicates that seniors would rather age and receive care at home, close to family and friends. With the right supports in place, this can be done for many of them. Long-term care homes should be used only for those who really need the level of care provided there.

The ministry has also announced 250 additional short-stay beds in long-term care homes across the province to help up to 1,500 more seniors get out of hospital sooner and move them to the community. In order to facilitate this, an additional 3 million personal support worker hours are being rolled out over the next three years to help people who wish to receive care at home.

The shift to community care, with a 4 per cent increase in funding each year for 3 years, means home care for 90,000 more seniors.

Over the next three years, the ministry has identified an investment of $5M, $10M and $20M for Independent Living – Direct Funding which supports the commitment of transitioning to a patient-centred system away from a provider-centred system. The Direct Funding program allows clients to manage both their care and the funding for that care. Clients receive funding and are empowered to coordinate and arrange for services to support themselves at home and at work.

Two community birth centres, one in Toronto and one in Ottawa, will be established to provide women with more choice on where to have their babies.

Enablers of Transformation

Community health care infrastructure

To improve care in the community, the ministry must improve community health care infrastructure.

Community based programs are facing a number of challenges in their current infrastructure. Over recent years, increases to services without corresponding capital funding support have led to overcrowding.

The ministry will therefore invest in capital projects in the community sector to enable the transformation work underway.

Over the next 3 fiscal years, the ministry has identified $5M, $10M and $15M in one‑time funding to support the development and/or the redevelopment of spaces that house community programs and services.

Over the longer term, the ministry will plan for an appropriate and sustainable level of capital investment with an enhanced focus on the community sector to bring the vision of the Action Plan to life.

Delivering the best health care to the people of Ontario where and when they need it while ensuring taxpayers get better value for their health dollars is part of The Way Forward in building a strong economy and a fair society for the benefit of all.

eHealth

eHealth initiatives enable health system modernization and lead to better, safer and more cost-efficient care. Electronic Health Records and other ehealth initiatives will help us improve the safety and the quality of, and access to, health care services. Investing in ehealth is part of the government's Action Plan for Health Care and its commitment to provide the People of Ontario with the right care, at the right time, in the right place, while ensuring that health care dollars are spent most efficiently.

The ministry and the Ontario Medical Association have partnered to introduce new measures that modernize the province's healthcare system. The changes will create new virtual channels of service - an integrated approach aimed at removing physical and policy barriers to care, creating new delivery channels through which patients and providers can engage the healthcare system.

Conclusion

The transformation taking place in Ontario is unprecedented in pace, scale and fiscal targets. Transforming the system will not be easy. The ministry is working within the old and new systems at the same time.

The ministry has to continue delivering high quality health services at the same time as setting in place the building blocks to enable a successful transformation of the system over the longer term.

The ministry will have to consider all policies and funding through a patient-centred and wellness lens, where providers will be accountable for the patient's journey, and not only within the delivery channel in which they operate.

As transformation progresses over the coming years, the people of Ontario can expect to see a relentless focus on the use of evidence to improve quality of care; a measurable shift in service provision in a way that better meets their needs; and managed growth in health care spending.

Ontario patients will receive care closer to home or even better, in their home. People will not need to wait in hospital hallways for lack of beds, because those who do not need to be in hospital will be cared for in a more appropriate setting.

Health care providers will be working within their communities to strengthen the capacity of the system to meet the needs of patients, while health care dollars will be invested in a more cost-effective health care delivery method.

The ministry's plan for transformation represents the next phase of its evolution from being in the business of delivering services years ago to the creation of LHINs and regional engagement, planning and funding models.

Now, the ministry is taking it further, looking to patients and their families, health care partners, organizations and clinicians to recommend areas for change and identify system redesign solutions.

In Ontario, we believe that everyone has a role to play in creating a better health care system and making healthy change happen.

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Financial Information

Table 1: Ministry Planned Expenditures 2013-2014 ($)


Ministry allocation of 2013-14 base spending ($48,854.9M)
Table 1: Ministry Planned Expenditures 2013-2014 ($)
Operating 47,522,015,860
Capital 1,302,915,100
Total Ministry 48,854,930,960

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Ministry of Health and Long-Term Care

Organizational Chart

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Agencies, Boards and Commissions

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Table 2: Operating and Capital Summary by Vote

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Appendix I: Annual Report 2012-13

Ministry of Health and Long-Term Care Overview

The Ontario government has continued on a path to transform the health care system to make the province the healthiest place in North America to grow up and grow old. The government is committed to building a person-centred health care system that better meets the needs of the people of Ontario today and of future generations. The Ministry of Health and Long-Term Care has continued to work with its partners and stakeholders to build an integrated health care system that is more responsive to patients, delivers high-quality services, improves outcomes and delivers better value for taxpayers. Building a sustainable health care system is not only essential for the health and well‑being of the people of Ontario, it is also imperative to respond to the ongoing fiscal challenges facing the province and the demographic reality of a growing and aging population, which will place unprecedented pressures on the health care system in years to come.

Ontario's Action Plan for Health Care

Ontario's Action Plan for Health Care was released by the government in January 2012. The plan sets an ambitious agenda to address the dual fiscal and demographic challenges facing the province. It lays out a plan to fundamentally transform how health care is organized and delivered in the province. The heart of the plan rests on two basic questions:

  1. Does this change mean better access and quality of care for the people of Ontario?
  2. Does it deliver better value for taxpayers?

The Action Plan is transforming health care to make sure that patients are put front and centre and spending is shifted to where it garners the greatest value for the investment and improves outcomes for patients.

The Action Plan involves improving the quality of care based on the best available evidence, providing better access to care and putting resources where people need them the most. Providing care close to home or at home is increasingly the most appropriate and efficient way to provide better access to health care services, particularly for the growing population of seniors.

Increasingly, this means putting more funding into home and community care, which is essential to support seniors living independently and with dignity in their community. Shifting more resources into the community will increase access to care where it is needed and at the same time, reduce spending in other parts of the system. The Action Plan involves building an integrated continuum of care so that appropriate health services and resources are put in place where they are most needed.

Making Healthy Change Happen

The Action Plan is the vehicle to making healthy change happen for the people of Ontario. The plan involves three overarching pillars that are the foundation of health system transformation:

  • Keeping the People of Ontario Healthy – focusing on wellness, prevention and health promotion.
  • Faster Access and Stronger Link to Family Health Care – ensuring patients have ready access to primary care providers to help them stay well and be connected with the appropriate treatment and services when they get sick.
  • Right Care, Right Time, Right Place – ensuring the best care is delivered based on the evidence, in a timely way and in the most appropriate place; in the community or at home wherever possible.

Keeping the People of Ontario Healthy

Helping people stay healthy is a primary goal and ongoing commitment of the government and is essential for the well-being of individuals and the sustainability of the health system. The more people can avoid getting sick in the first place, the better it is for their quality of life and the less it costs to provide care. The government has increased its efforts to promote healthy habits and behaviours, supporting lifestyle changes and better managing chronic conditions. Tools and other supports have been provided to assist people coping with chronic illness to better self-manage their conditions. This will help them to live their lives to the fullest, while avoiding getting sicker and needing more costly interventions.

Renewing Smoke-Free Ontario Strategy

As part of its commitment to keep the people of Ontario healthy, the government has set a goal for having the lowest smoking rate in Canada. A continued war on smoking is essential because it remains the number one cause of death and disease in Ontario. Each year, 13,000 people in the province die from smoking-related illnesses. Each year, tobacco-related diseases cost the province $1.93 billion in direct health-care and $5.8 billion in productivity losses.

Ontario's Smoke-Free Ontario Strategy continues to be one of the most comprehensive in North America and it includes programs, policies, legislation and public education aimed at preventing youth from starting to smoke, helping smokers quit and protecting people from exposure to second-hand smoke. Since 2005, government supported initiatives have helped more than 1.37 million people quit smoking.

The government has renewed and strengthened its commitment to a Smoke-Free Ontario by introducing new measures to help more people quit smoking and ensure that young people do not become addicted. The measures include:

  • Expanding access to no-cost nicotine replacement therapies and counseling for smokers in primary care settings, including Family Health Teams,  Aboriginal Health Access Centres, Community Health Centres and addictions services
  • Hiring full-time Youth Engagement Coordinators in each of the province's 36 Public Health Units to be resources for youth tobacco control activities in their communities.
  • 128 Family Health Teams and 43 Community Health Centres across Ontario are now providing over-the-counter nicotine cessation aids and counseling, at no cost to smokers.
  • Increasing support for people who smoke, with hospital-based cessation initiatives in 14 locations and workplace-based cessation programs in collaboration with 11 public health units.
  • Helping patients at hospitals quit smoking through various strategies such as providing counselling, and improving care for patients with chronic conditions such as asthma, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and lung cancer.
  • Helping Ontario Drug Benefit (ODB) clients by providing funding for smoking cessation drugs and counseling through the ODB program.

These new initiatives build on the success of other supports for smokers offered in Ontario, including the Canadian Cancer Society's Smokers' Helpline that offers cessation support through phone, online, text messaging and regional coordination services.

Brock University's Leave the Pack Behind provides access to cessation services for students with programming and services at all of Ontario's public colleges and universities.

Childhood Obesity

Childhood obesity rates have increased over the years, with 27 per cent of children in Ontario, two to 17 years of age identified as being either overweight or obese (2004 CCHS).  Tackling childhood obesity is essential to prevent the next generation from being overburdened by chronic diseases associated with obesity such as diabetes, high blood pressure and cardiovascular illnesses.

As part of the Action Plan, the government has set an ambitious target of reducing childhood obesity by 20 per cent over five years. In May 2012, the government created the Healthy Kids Panel, which brought together 18 independent experts from a broad variety of sectors, including advocates, health care leaders, non-profit organizations and industry to develop recommendations on how to meet the government's target.  The government released the panel's recommendations in early March 2013 and committed to implement as many as possible.

The government also continued to support a number of ongoing programs that address the risks linked to childhood obesity. These include:

  • EatRight Ontario – the program offers email and toll-free telephone access to registered dietitians who can provide advice on nutrition and healthy eating. The EatRight Ontario website offers tools such as meal planners and resources to support the development of healthy eating.
  • The Northern Fruit and Vegetable Program – provides fruits and vegetables, along with educational materials, for elementary school children in northern communities of the province to increase their access to nutritious produce. About 18,000 students in 106 schools have been provided with fruit and vegetable snacks.
  • Healthy Communities Fund (HCF) Grant Program – provides non-capital grants to organizations that deliver integrated health promotion initiatives in communities across Ontario. To-date the government has invested over $38 million in more than 750 grant projects to help local and provincial organizations promote physical activity, healthy eating, injury prevention, tobacco control, prevention of substance misuse and mental health promotion.
  • The Student Nutrition Program – provides healthy breakfasts, snacks and lunches in schools and community agencies in communities across Ontario to ensure children have nutritious food to eat to support learning.

Cancer Screening and Prevention

The government has built comprehensive, integrated cancer screening programs and is committed to continue to increase screening rates for cervical, breast and colorectal cancer. Screening reminders are sent to patients and people at high risk are linked to prevention supports or genetic testing. The highlights include:

  • The ColonCancerCheck program, a population based screening for average risk Ontarians for colorectal cancer using a Fecal Occult Blood Test (FOBT). In 2012-13, 545,100 FOBT screens were completed for individuals aged 50-74. Since the start of the program in April 2008, 2,865,907 FOBT screens were completed for individuals aged 50-74. The government continues to promote colorectal screening because Ontario has one of the highest rates in the world and more than 3,000 people die from it each year, although it is 90 per cent curable if detected early.
  • A $15M investment over 3 years (2011-14) to expand the Ontario Breast Screening Program to high risk women 30-69 years and provide additional breast screens to women at high risk for breast cancer at a total of 28 sites.
  • 463,923 Ontario Breast Screening Program screens performed for average risk women in 2012-13.
  • Offering each year to approximately 75,000 female Grade 8 students publicly‑funded, three-dose series of the HPV vaccine to protect against the human papillomavirus virus (HPV), which can cause cervical cancer as well as genital warts. The vaccine saves families up to $405 per child if paid for out of pocket.
  • Continuing to fund Prostrate-Specific Antigen (PSA) testing for men meeting the OHIP eligibility criteria in hospitals and the community laboratory sector.
  • Funding Cancer Care Ontario to create an online tool that uses medical/family history to assess personal cancer risks to identify Ontarians requiring genetic testing, prevention supports or screening.

Chronic Disease Management

Nearly four million people in Ontario over age 45 are coping with a chronic disease ‑ and about 70 per cent of these people are struggling with two or more chronic conditions. These statistics will only increase as the province's population continues to age rapidly. Chronic diseases that are not well managed have a significant negative impact on the quality of life of individuals and families and on the health care system.

The Ontario Diabetes Strategy

About 1.2 million people in Ontario are living with type 1 or type 2 diabetes. By 2020, that number is expected to increase to 1.9 million. The government has continued to focus on expanding diabetes programs and services to improve the health care services and quality of life of those living with the disease and support those at risk of developing diabetes.

The key accomplishments of the Ontario Diabetes Strategy (ODS) include:

  • Increasing the number of Diabetes Education Teams (DETs) from 220 to 321 across the province to help people better manage their diabetes and prevent or minimize the impact of diabetes related complications.
  • Creating Diabetes Regional Co-ordination Centres in each of the 14 Local Health Integration Network regions to co-ordinate diabetes services and care, and foster adoption of clinical best practices.
  • Setting up six Centres for Complex Diabetes Care (CCDCs) in Ontario to provide specialized, patient-centred care and treatment for people with complex diabetes and related health challenges.
  • Evidence-based diabetes self-management education and skills training has been provided to more than 5,500 individuals and more than 5,000 health care providers.
  • Over 6,300 physicians, representing over 619,000 people with diabetes, participated in the Baseline Diabetes Dataset Initiative to raise awareness of the importance of regular diabetes management testing.
  • Health promotion initiatives for diabetes prevention have been delivered in 119 communities across Ontario reaching more than 41,000 individuals who are at high risk for developing type 2 diabetes.

Chronic Kidney Disease Management

The government has committed in recent years to support the early identification and intervention of Chronic Kidney Disease (CKD) Management. A range of clinical services have been implemented with the goal of slowing the progression of the disease and a patient's need for dialysis treatment.

From 2011-12 to 2012-13 the funding provided for chronic kidney disease increased the total number of dialysis patients treated in Ontario by 5 per cent.

The province has also established innovative sites offering CKD services, including a co-location with a long-term care facility, a community health centre serving an aboriginal population and a community wellness centre. Increased services have also been developed to offer more patients the opportunity to receive dialysis treatment in their homes.

Immunization

Immunization programs help keep the people of Ontario healthy and build a more resilient population that is less likely to get sick and in need of acute health care services. Immunization is a crucial health promotion and protection strategy to improve people's health and well-being. The government maintains its commitment to accessible publicly funded immunization programs that protect children, adolescents and adults from a variety of potentially life threatening vaccine preventable diseases.

Immunization programs have been expanded to 21 vaccines protecting against 16 diseases. New vaccines are providing protection against: pneumococcal disease, meningococcal disease, chickenpox, cervical cancer, and rotavirus.

These programs save Ontario families up to $1042 per child if paid for out of pocket. Adolescents are provided with a number of immunizations at no cost that protect against diseases such as hepatitis B, HPV (for females), meningococcal disease, and a booster dose that protects against tetanus, diphtheria, and pertussis.  These publicly funded vaccines save Ontario families up to $694 per school-aged child if paid for out of pocket. Adults in Ontario are eligible to receive a booster dose of vaccine every 10 years to protect them against tetanus and diphtheria, and seniors are eligible to receive a dose of pneumococcal vaccine

In addition, everyone living in Ontario over six months of age is eligible to receive a free annual seasonal influenza vaccine under the province's Universal Influenza Immunization Program, which has significant impact in reducing the rate of illness and the burden caused by influenza, especially for those at higher risk of complications, such as young children and seniors.

Newborn Screening

To prevent disease and promote better health, it is important to foster a healthy childhood and beyond. That is why the government has invested in the most comprehensive newborn screening program in Canada. The program – based out of the Children's Hospital of Eastern Ontario – screens for disorders such as sickle cell disease, cystic fibrosis and Severe Combined Immune Deficiency (SCID).

An expert advisory committee provides ongoing advice to the newborn screening program.

Dental Care

In addition to public health dental services, the government currently funds two treatment programs to increase access to dental services for children and youth from low-income families. Ontario is investing $38 million annually to expand the Children in Need of Treatment Program (CINOT) and to introduce the Healthy Smiles Ontario (HSO) program. Both programs are administered by Ontario's public health units.

In 2012, CINOT paid for the emergency care for 33,548 children and youth with serious oral health problems who may have otherwise gone untreated.

HSO provides free preventive and basic treatment services to children and youth 17 years of age and under from low-income families. As of February 2013, over 38,000 children have enrolled in the HSO program, who may have otherwise gone untreated.

HSO expands accessibility to dental services through public health units, which offer oral health services in innovative ways – including mobile dental units that can be deployed to serve northern and remote populations – to best address the needs of their local communities. The HSO program also partners with other local organizations, including Community Health Centres.

MedsCheck

Through the MedsCheck program, the government has put tools into people's hands to help them cope with multiple chronic conditions by better managing their prescription medications. For 2012-13, over 1.3 million MedsCheck services were provided at a cost of $79 million. MedsCheck is helping more people stay healthy and safe as they live with multiple chronic diseases.

Since its inception, MedsCheck has been expanded to include the following additional areas:

  • People in Ontario living with type 1 or type 2 diabetes;
  • Individuals who are home-bound and have difficulty traveling to a pharmacy. In this case a community pharmacist visits the person in their home for the review; and
  • Ontario residents living in long-term care homes – making the program available to about 77,000 people.
  • Ontario Drug Benefit recipients who smoke – pharmacists are available to provide counselling through the Pharmacy Smoking Cessation Program

MedsCheck is helping more people stay healthy and safe as they live with multiple chronic diseases.

eHealth Records

Electronic health care is becoming an increasingly important tool and enabler for improved access to quality patient care and innovation across Ontario. It will help transform the health care system from using predominantly paper-based records to fast, efficient and secure electronic sharing of data among authorized health care providers anywhere in the province.

The Ontario government's investments in ehealth are already benefiting the people of Ontario today, among which:

  1. Electronic medical records (EMRs) that record a patient's interactions with their health care provider to better support the sharing of health information.  EMRs improve patient care and create a more responsive and value-based health care system. As of December 2012, more than 10,000 clinicians representing nine million patients either had an EMR or were in the process of implementing one.
  2. The Diagnostic Imaging and Picture Archiving Communications System (DI/PACS) that enables hospitals to produce and share filmless diagnostic images including X-rays, CT scans, ultrasounds and MRIs within their facilities.  All Ontario hospitals are now using digital diagnostic imaging and the majority are connected to regional repositories that enable them to electronically share these images with other connected hospitals.
  3. Telemedicine provides quality health care for Ontario's widely dispersed population through the use of video conferencing and other advanced information and communication technologies. In 2012-13, the Ontario Telemedicine Network enabled over 308,000 patient consultations through telemedicine, reaching an estimated 110,000 unique patients across Ontario and delivering over 236,600 direct patient clinical encounters across over 1,600 sites in Ontario.

Faster Access And Stronger Link To Family Health Care

To keep healthy, it is essential for people to be able to access family health care when they need it. The government has made significant investments to increase the numbers and availability of doctors and other primary care providers in the province. Ontario has also supported and expanded implementation of innovative interdisciplinary primary care group models that can provide better integrated care for more patients.

Family Health Teams

There are currently 200 Family Health Teams (FHTs) in operation in Ontario serving nearly three million patients and growing. This innovative primary health care model was launched in 2005 to improve and expand access to comprehensive family health care delivered by an interdisciplinary team of health professionals working together to best serve the needs of patients.

About 718,000 people who previously did not have a family health care provider are now being served by a FHT. There are over 2,450 doctors and 1,800 interdisciplinary health professionals, including nurse practitioners, social workers and dietitians working in FHTs. By working as a broad-based team, FHTs can see more patients and physicians are freed up to spend more time with patients with complex health needs.

FHTs offer a range of integrated services for their patients that are geared to the needs of their local community, such as chronic disease management, smoking cessation, mental health and the care of seniors. The comprehensive coverage provided by FHTs helps to achieve a range of government priorities, including avoiding unnecessary emergency room visits.

Nurse Practitioner-Led Clinics

Nurse Practitioner-Led Clinics (NPLCs) are another innovative primary health care model. As of January 2013, 26 NPLCs were operational with 24 now serving more than 32,900 patients and climbing – many of whom previously did not have a primary health care provider. NPLCs are providing primary care services often in previously under‑served communities. Similar to FHTs, NPLCS are interdisciplinary teams improving access to care.

Health Links

The need to better integrate the delivery of health care services is most clearly illustrated in relation to patients coping with a number of complex conditions. These patients tend to have multiple and frequent interactions with the health care system and often are seeing a range of providers for health concerns and services. Complex patients represent about five per cent of Ontario's population, but use about two-thirds of the health care budget. Such patients include seniors, individuals with multiple chronic diseases and people coping with mental health and addiction issues.

To better support the system in serving the needs of complex patients, in December 2012 the Minister announced the creation of a community-based model called Health Links.

Health Links will encourage greater collaboration and co-ordination among a patient's different health care providers. Personalized care plans will be developed for patients, starting with the complex, and providers will be collectively accountable for outcomes.

Health Links will help improve the transitions of complex patients within the system and help to ensure they receive responsive care that addresses their specific needs with the support of a tightly knit team of providers.

Health Links will measure results and target the following:

  • Improving access to family care for seniors and patients with complex conditions;
  • Reducing avoidable emergency room visits;
  • Reducing unnecessary re-admission to hospitals shortly after discharge;
  • Reducing time for referral from primary care doctor to specialist appointment; and
  • Improving the patient's experience during their journey through the health care system.

Twenty-five Health Links have been established to date, with the goal to expand across the province over time.

Health Links are a flexible community based model and can vary from another in terms of leadership structure and the composition of provider organizations involved. But each Health Link will include significant representation from primary care providers, community services and hospitals in its local catchment area.

Health Links will operate at a sub-LHIN level and will be supported by their regional LHIN, the ministry and other system stakeholders. Health Links represent a piece of the puzzle in improving access and outcomes for people who are struggling to cope with their complex conditions and who currently have a significant impact on health care spending.

Community Health Centres/ Aboriginal Health Access Centres

Community Health Centres (CHCs) and Aboriginal Health Access Centres (AHACs) improve access for people who often face social and economic barriers to accessing health care programs and services. They reach underserved populations and groups with unique needs, like new immigrants. They focus on the social determinants of health by delivering a broad range of primary care, as well as health promotion and community development services. Healthy eating, active living and community gardens are among the programs that can be found in CHCs in Ontario.

There are currently over 100 CHCs locations in Ontario which is an indication of the government's continued commitment to this model that improves access to care for some of the province's most vulnerable residents. CHCs are currently caring for more than 383,400 people in Ontario.

Health Care Connect

Since 2009, the Health Care Connect (HCC) program has been helping people in Ontario who do not have a family doctor or Nurse Practitioner to find one. Ontarians can call 1-800-445-1822 to register with HCC or register at the website (www.ontario.ca/healthcareconnect). People who have the greatest health needs are referred first. As of January 2013 over 189,000 Ontarians have been referred using this service.

Physician Supply

In response to evidence-based needs, Ontario has significantly increased the number of doctors working in the province in the last nine years to improve access to care. There were 25,480 practising in Ontario in 2011 compared to 24,875 in 2010.

To help drive the overall increase in physicians, the government has made significant investments to "right-size" the medical training system. Four new medical education campuses in St. Catharines, Kitchener-Waterloo, Windsor and Mississauga are successfully operating and training doctors.

In 2012, 17 out of 54 MD students from Northern Ontario School of Medicine's undergraduate program chose to continue to train in residency programs offered in Northern Ontario. Specialties to which students matched include: family medicine, psychiatry, anesthesia, dermatology, orthopedic surgery, general surgery, radiation oncology, internal medicine, obstetrics and gynecology.

Through HealthForceOntario – the province's health human resources strategy – the government created the Northern and Rural Recruitment and Retention Initiative to help attract more physicians, including new graduates, to rural and northern communities through financial incentives.

The government also continued to improve access to care by expanding opportunities for International Medical Graduates (IMGs) to practice in the province. Ontario currently offers more training positions and assessments for IMGs than all other provinces combined.

IMGs account for approximately 25 per cent of the province's physician workforce.

In 2012-13, Ontario offered 235 training positions to IMGs.

New Physician Services Agreement

The 2012 Physician Services Agreement, which was signed by the Ministry and Ontario Medical Association (OMA) on December 11, 2012, was ratified in December 2012 by 81 per cent of OMA members. The agreement will improve patient care, achieve better value for health care dollars spent and allow the province to make health care investments were they are needed the most. The agreement protects and builds on the gains Ontario has made for patients over the last nine years.

The agreement will be in place until March 2014 and includes the following key elements:

  • Modernizing the delivery of health care and lowering wait times through e‑consultations, enabling patients to communicate with their doctor more easily, allowing for more virtual connections between family doctors and specialists, and an expansion of telemedicine services.
  • New priority investments to expand access to family doctors for seniors and patients with higher needs, including an expansion of house calls.
  • New evidence-based changes that support the sustainability of the health care system and the protection of high quality patient care, including: reducing unnecessary pre-op cardiac testing for low-risk, non-cardiac patients; modernizing the annual health exam, personalizing it to the individual needs of healthy adults and reducing unnecessary tests; and aligning the frequency of colonoscopies and cervical cancer screenings to meet Cancer Care Ontario guidelines.

Expanding Role of Pharmacists

As part of the Action Plan for Health Care, the government approved regulations in October 2012 to allow pharmacists to offer more health services to the people of Ontario. These changes provide improved access to care as pharmacists can now administer flu vaccines, renew and adapt existing prescriptions and prescribe smoking cessation drugs and a number of other services. As of January 2013, 619 pharmacies were participating in the province's Universal Influenza Immunization Program.

Nurses

Nurses are an important component of improving access to care. In 2012, Ontario had 127,611 nurses compared with 126,573 in 2011.  Ontario continues to be one of the few jurisdictions in the world to guarantee a full-time job opportunity to new nursing graduates. Since 2007, more than 14,300 new nursing graduates have received a full‑time job opportunity through the Nursing Graduate Guarantee. Overall, the percentage of nurses working full-time in Ontario was 66.6 per cent in 2012 compared to 66.4 per cent in 2011.

Under the Late Career Nurse Initiative, Ontario continued its commitment to retain the expertise of experienced nurses in the workplace by providing them the opportunity to spend more time in less physically demanding roles.

The government continued to support a number of programs to improve the working conditions and work environments of nurses. This included investing in the Quality Nursing Environments-Quality Patient Care Fund to enhance nursing practice environments and increase the amount of time frontline nurses can spend delivering direct patient care.

Midwives

Midwifery care results in fewer medical and surgical interventions, which benefits mothers and babies and provides better value to the health care system. Up to 22,000 babies are currently delivered by midwives annually in Ontario. The province has over half of Canada's midwives.

In 2012-13, access to a midwife was expanded for thousands of women by supporting the services of up to 80 more midwives.

Funding for the Ontario Midwifery Program has increased from $23.7 million in 2002-03 to approximately $117.6 million in 2012-13.

There are approximately 640 registered midwives in Ontario. The province also amended the Midwifery Act, effective September 1, 2011, to expand the scope of practice of midwives working in Ontario.

Physician Assistants

As of June 2012, there were over 110 physician assistants (PAs) working in over 70 demonstration sites in the province. PAs are currently working as part of inter-professional teams in emergency departments, other hospital departments, community health centres, Family Health Teams, and in diabetes and long-term care patient management settings. Evaluation results from the current placements will inform decisions on the future role of PAs within the health system.

HealthForceOntario

HealthForceOntario (HFO) - the government's health human resources strategy, continues to play a leading role in ensuring Ontarians have access to the right number and mix of qualified health care providers, now and in the future. Through HFO, the province's needs for health professionals continue to be identified and anticipated.

As part of the strategy, the government has successfully engaged partners to develop skilled, knowledgeable providers and create health care delivery teams that will make the most of their abilities. The government has helped introduce new and expanded provider roles to increase the number and mix of health care professionals working in the system and build on the skills of those already there.

The HealthForceOntario Marketing and Recruitment Agency continues to be actively involved in recruiting and retaining health professionals in communities across Ontario and manages one of the most comprehensive health job recruitment websites in North America.

Right Care, Right Time, Right Place

It is essential to the health and well-being of the people of Ontario that they get the right care they need at the right time and in the right place.  This is also crucial for the ongoing sustainability of the health system.

A key focus of the Action Plan for Health Care involves shifting care to the most appropriate place to deliver patient-centred, high quality care resulting in the best outcome and making the best use of health care resources. In many instances the right place is in the community or a patient's own home, whenever possible.

The government remains committed to exploring opportunities and taking steps – where appropriate – to shift some routine clinical procedures from an acute setting to the community where the health services will be more appropriately accessible to patients.

Community-Based Specialty Clinics

Health care provided in the community is in general more affordable than care in hospitals or long-term care homes. Ontario has some of the best hospitals in the world and they are second to none in providing acute care services. But where high quality health services can be delivered safely and effectively in the community, it makes sense for patients and the sustainability of the health system to do so.  This is why the government moved forward in 2012-13 with its plan to shift clinician procedures – where appropriate and possible – into specialty not-for-profit clinics in the community. It has been demonstrated that specialty clinics, which focus on few procedures can serve more patients, more quickly with excellent outcomes.

The first of two new midwife-led birth centres, the Toronto Birth Centre, expects to provide services for between 450-500 births annually, will improve access and provide greater choice for women as to what setting they choose to deliver healthy babies. It will also help to free hospital beds to focus on high-risk births.  A second birth centre for Ottawa was announced in December 2012 and will also provide services for between 450-500 births annually.

Vision care will be another key area of focus for not-for-profit specialty clinic expansion. Calls for applications for vision care clinics, performing procedures such as cataract surgeries, will be announced by spring 2013.  Following the vision care call for applications, the government will move forward with expanding non-profit clinics for procedures such as colonoscopy, dialysis, orthopaedic and diagnostic services.

Independent Health Facilities

The Independent Health Facilities Act (IHFA) provides a way to fund facility costs associated with insured surgical and diagnostic services, and to regulate and ensure the quality of these services when performed in licensed community-based facilities.  There are about 940 licensed diagnostic and surgical/treatment facilities in the province providing services such as radiology, ultrasound, cataract surgery and dialysis. Licensing commenced in 1991 following proclamation of the Act In 1990. In 2012-13, Kensington Eye Institute, a facility licensed under the IHFA, received funding to provide an expanded volume of cataract surgeries and an expanded scope of eye surgeries, such as glaucoma, vitreoretinal and cornea surgeries.

Home Care

Home care services are a critical component of our health care system and are important to help people live independently at home for as long as possible.  Ensuring services, such as home care, are available has become particularly important given the expected increase in the number of seniors in Ontario.

The government committed in 2012-13 to invest new funding to provide 90,000 more seniors with home care services and an improved quality of life by adding three million more Personal Support Worker (PSW) hours over the next three years to assist seniors – and others with complex health needs – with a range of essential daily activities.

Ontario is committed to taking other steps to prepare the health care system to better meet the needs of an aging population through the launch of a new Seniors Strategy. The government is supporting seniors to live independently in their own homes through the new Healthy Home Renovation Tax Credit that makes it more affordable for seniors to physically adapt their homes with modifications that can improve safety and access. Supporting seniors to live independently in the community can reduce or delay use of more costly health system resources such as hospitals and long-term care homes, while improving their quality of life.

Funding for Community Care Access Centres (CCACs), which arrange for the provision of home care services and manage admission to long-term care homes and other care settings, increased in 2012-13 by $43.2 million or 2 per cent over 2011-12. The 2012 Provincial Budget committed to increase funding for home and community services by an average of 4 per cent over three years.

Community Support Services

Community support services are essential to help more than 1.5 million people in Ontario, who require a range of services to support seniors and people with disabilities to live independently in their communities. Services include meals on wheels, transportation services, caregiver respite and home maintenance and repair. The budget for community services, including community support services, assisted living services in supportive housing, and acquired brain injury services, has increased by $5.2 million or 1.2 per cent over 2011-12.

Community Mental Health and Addictions

The right care at the right time in the right place is critical in the area of mental health and addictions services. Seventy per cent of mental health problems first appear in childhood and adolescence. So early intervention is essential to try and curb the challenges of a lifelong mental illness.

As a result, the province's comprehensive mental health and addictions strategy has a special focus on children and adolescents in the first three years. The government funds registered nurses to work as part of early psychosis intervention teams across the province, to more effectively respond at the onset of a mental illness. Ontario also continues to make significant investment in services to help keep people with mental illness out of the criminal justice and corrections system, including: crisis response outreach, court support services and intensive case management services.

Local Health Integration Networks

Local Health Integration Networks (LHINs) play a key role in helping to integrate health services in a specific geographic area and supporting improvements that assist people in better navigating the health system across the continuum of care, as patients move from primary care, to hospital and back into the community or long-term care.

LHINs have accountability agreements with each of their health service providers that ties funding to results.  For the first time in Ontario:

  • we are measuring health care performance
  • setting targets based on these measures
  • holding organizations accountable for achieving these targets, and
  • publicly reporting performance results.

In support of the Action Plan for Health Care the government has asked the provinces 14 LHINs to allocate funding to address three priority areas:

  1. Reducing ER wait times and Alternate Level of Care rates;
  2. Reducing avoidable hospital readmissions; and
  3. Increasing access to mental health and addictions services.

LHINs will continue to assist in the government's efforts by supporting innovative and community-based solutions such as Community Health Links to improve access and achieve better system integration.

Supporting Alternatives to the Emergency Room and Reducing ER Wait Times

In order to strengthen the overall health system, the government has invested extensively in a number of co-ordinated initiatives to expand alternatives to emergency room services so that Ontario's ERs are not routinely used as default entry points into the health system. When patients rely on ERs when their need for health services can be more appropriately addressed elsewhere in the system, it contributes to longer wait times in ERs and puts undue burden on more costly acute care services.

The government has also committed resources to improve performance in the province's ERs and support timely discharge to appropriate care in the community. For the future sustainability of the overall health system, it is essential that the province's precious health care resources are consistently used appropriately.

In 2012-13 investments were made in four key initiatives to support these objectives:

  • Pay-for-Results program that provides funding incentives to 74 high volume ERs across the province to reduce wait times;
  • Alternate Level of Care (ALC) Resource Matching and Referral Business Transformation Initiative to streamline and standardize patient referrals;
  • Nurse-Led Long-Term Care Outreach Teams across 14 LHINs to reduce transfers of Long-Term Care residents to ERs;
  • Website and Kiosks to inform people about settings other than the ER to receive care.

Health Care Options

The government continues to be committed to providing the people of Ontario with up‑to-date information and tools to support and engage them in making better informed decisions to get the health care services they need, when and where they need them.

The Health Care Options (HCO) website has been operational for the past four years to provide information on the range of health service options that exist in Ontario communities. The HCO website allows individuals to search for health care services in their community by postal code to find options close to home. HCO provides patients with information that help them make the most appropriate choice about their health care needs and also eases the burden on acute care services, like hospitals, which supports the whole system in working better.

Reducing Wait Times

In 2012-13, the government invested $75.1 million in additional capacity in Ontario's Wait Times Strategy (WTS) in hip and knee revisions, general surgery, paediatric surgery and MRI and CT scans. Additional one-time funding for paediatric surgeries ($0.6 million) and MRI scans ($4.1 million) was targeted to facilities with the longest wait times to support sustainable strategies to achieve wait time access targets.

In 2012, Ontario was once again the national leader in reducing wait times for five priority health services, according to a report card issued by the Wait Time Alliance.

Ontario's Wait Times Strategy is committed to:

  • Increasing the number of procedures for each of these services;
  • Investing in new, more efficient technology such as MRI machines;
  • Standardizing best practices; and
  • Collecting and reporting wait times data to allow better decision-making and increase accountability.

Ontario's ground-breaking website continues to publicly record and inform about current wait times for hospitals across the province for key health services at www.ontario.ca/waittimes.

Reducing wait times for key services continues to be an important component of the government's overall agenda to transform the health system to better respond to the needs of patients, improve quality and outcomes.

Long-Term Care

Community and home-based care are at the heart of the Action Plan for Health Care, but it is also essential that people who need it can count on accessible, high-quality long-term care. Long-term care (LTC) home beds are necessary for the most complex and fragile elderly individuals who can no longer cope at home or in a community-based setting.

The government has demonstrated its ongoing commitment to LTC homes in Ontario. Funding in 2012-13 has increased by $104.21 million or 2.9 per cent over 2011-12. LTC home residents continue to be protected by the comprehensive Long-Term Care Homes Act, 2007 (LTCHA) that was proclaimed into force on July 2010 and captures the following key features:

  • Policy to promote a zero-tolerance approach to prevent abuse and neglect of residents
  • Enhanced reporting obligations for anyone aware of abuse, neglect, etc.
  • Enhanced whistle blowing protections for individuals who report to an inspector or the director
  • An enhanced and more clearly enforceable Residents' Bill of Rights
  • Strengthened and consistent reporting requirements for homes on abuse, neglect, and on critical incidents such as injuries.
  • Strengthened requirements related to the development of an integrated, interdisciplinary plan of care for every resident
  • Detailed and comprehensive "least restraint policy" to minimize the use of restraints 
  • Improvements to the assessment and admission process
  • A substantively reformed and strengthened compliance inspection and enforcement system which introduces new sanctions that are appropriate for the sector.

The government has also increased nursing, personal care, programming and support services for LTC residents. Residents and their families continue to benefit from a 1-800 Action Line (i.e., 1-866-434-0144) that provides a province-wide toll free information and complaint line.

End of Life and Palliative Care (HSSD)

The people of Ontario deserve quality care at every stage of their lives, including at the end of their lives. So the government has made palliative care a priority. The ministry has worked collaboratively with the Local Health Integration Networks and sector partners to develop a shared Declaration of Partnership and Commitment to Action, which outlines a vision for palliative care in Ontario and the shared priorities and actions for all partners to take in order to achieve the vision.

As part of the Ministry's 2005 End-of-Life Care Strategy, 34 residential hospices or communities were identified and CCACs were given funding to use on palliative and end-of-life care in the community. Base funding was increased by $7 million starting in 2011 to enhance nursing and personal support services delivered through the CCACs in the province's 24 operational residential hospices.

Palliative home care supports also allow those who choose the option of living and dying in their own homes to do so with dignity.

Enablers

Key structures have been put in place and changes implemented to support transformation of the health systems as outline in the Action Plan for Health Care.

Health System Funding Reform

If the province is to be successful in transforming the health care system, it must reform the way it funds the system.

The province has started to implement Health System Funding Reform for Ontario's health service providers. This involves a gradual shift from a global budget model based on historic funding levels. Many major international jurisdictions have moved away from global funding in their health services. The province's health service providers will increasingly be funded on the basis of the characteristics of their patients and the amount and type of health care services they provide.

The Health System Funding Reform approach includes two key elements: a Health Based Allocation Model (HBAM), which factors in the population dynamics and health profile of a provider's user population. In addition, targeted clinical procedures will be funded using a Quality Based Procedures (QBP) model.

The QBP model involves clinical expert advisors developing evidence informed standards of care that will be used to set evidence-based prices. This approach will create incentives for health service providers to adopt best-practices in delivering care, as they will be provided with a single payment for a patient receiving treatment for a specific diagnosed condition and included in a specific care delivery pathway.

The ministry began phasing in Health System Funding Reform as of April 1, 2012. The year-one QBPs have already been rolled out to the hospital and, in certain cases, CCAC sectors for a targeted set of clinical areas that offer opportunities to improve quality of care outcomes, reduce practice variation and gain cost efficiencies. The first four QBPs introduced were: chronic kidney disease, cataract surgery, hip replacement and knee replacement.

The following additional QBPs will be implemented in Year 2 of HSFR:

  • GI Endoscopy/colonoscopy
  • Stroke
  • Congestive Heart Failure
  • Chronic Obstructive Pulmonary Disease
  • Chemotherapy – Systemic Treatment
  • Vascular (Non-Cardiac)

Both HBAM and Quality Based Procedures will comprise a greater proportion of health service provider funding over time. Global funding will be reduced in relative proportion as funding based on Health System Funding Reform increases. For example, for hospitals, at the end of three years, HBAM is expected to make up approximately 40 per cent of the previous global budget and Quality Based Procedures will make up approximately 30 per cent, for a total of 70 per cent of previous global funding.

More than 100 hospitals in the province are currently transitioning to this modernized funding approach to reflect population growth, clinical needs and ensure quality procedures. However, 54 small hospitals in Ontario have been excluded from the new model to recognize the unique role they play within their communities. The small hospitals will be encouraged to move towards adopting the best practice standards to improve patient outcomes, even where they are not included in the funding approach.

The ministry is also expanding funding reform into the community sector, where HBAM currently accounts for about 30 per cent of overall funding for Community Care Access Centres, which also receive QBP funding for hip and knee replacement rehabilitation.  Long-term care homes already receive funding based on Health System Funding Reform to a significant degree, through the Case Mix approach, and further reforms are planned for the sector .In addition, work is underway to define from more diagnostically-based to population-based QBPs.

Other jurisdictions which have adopted funding models similar to Ontario's Health System Funding Reform have reaped benefits, such as decreased wait times and a higher number of procedures performed. Sweden adopted a similar model in 1992, England in 2003 and here in Canada – British Columbia and Alberta in 2010.

For 2012-13, hospital funding has increased by 1.5 per cent over the previous fiscal year.Going forward, hospital funding will be increasingly more focused on patients and the delivery of care, rather than focused on service providers or health care organizations.

Health Quality Ontario

Providing the right care is critical to the Action Plan and the success of health system transformation. This requires making clinical decisions based on the best available evidence. It also necessitates fostering a culture of continuous quality improvement across the entire health care system.

The government established Health Quality Ontario (HQO) on April 1, 2011 to help support and focus quality improvement across the health system. In addition, HQO advises the government on the best available evidence to support clinical funding decisions of publicly ensured health care services. HQO was formed through a consolidation of various quality improvement initiatives that had been operating in various sectors of the health care system.

HQO has worked closely with the hospital and LTC sectors to bring about tangible quality improvement changes. As of the last quarter of fiscal 2012-13, HQO was expanding its role in supporting the primary care sector to advance quality improvements in this area.

HQO will support the implementation of the Excellent Care for All Act, 2010 (ECFAA) and move the priorities set out in the Action Plan for Healthcare in Ontario.  Examples of HQO's contribution to advancing the Action Plan:

  • HQO's evidence development through its work on quality based procedures (QBPs); this includes work in the areas of Congestive Heart Failure, Stroke, and Chronic Obstructive Pulmonary disease which will form the foundation for the Health System Funding Reform initiative
  • HQO's evidence-based care recommendations have resulted in savings to the healthcare system.  Most recently in revisions in to the Schedule of Benefits for Laboratory Services (Laboratory Schedule) (such as the restriction of Folate and AST).  The ministry continues to work closely with HQO to ensure health dollars are being spent according to clinical best practices.
  • HQO's bestPATH initiative supports the achievement of more coordinated, person-centred care for seniors and others with complex chronic illness. Specifically, bestPATH is a key enabler for Health Links communities as they work to improve access to care, reduce avoidable emergency room visits and unnecessary readmissions, and improve the patient's experience during their journey through the health care system.
  • HQO has worked closely with the hospital and LTC sectors to bring about tangible quality improvement changes. As of the last quarter of fiscal 2012-13, HQO was expanding its role in supporting the primary care sector to advance quality improvements in this area.

The ministry continues to work closely with HQO to ensure health dollars are being spent according to clinical best practices.

Excellent Care For All Act

The Excellent Care for All Act, 2010 (ECFAA) puts patients first by strengthening the health care system's organizational focus and accountability for delivering high quality patient care. Since ECFAA was implemented, all hospitals in the province develop annual Quality Improvement Plans (QIPs), which are publicly posted as well as submitted to HQO. The QIPs detail the organization's commitment to high quality health care, create a positive patient experience and ensure the hospital is responsive to the public and its executive team is accountable for the organization's achievements. In partnership with HQO, the ministry provided guidance and support to assist hospitals in the development of their annual QIPs, aligned with health system priorities.

Quality Improvement Plans in Primary Care

Guided by the experience of Ontario hospitals, the ministry, in collaboration with HQO, began supporting the primary care sector in 2012-13 to develop Quality Improvement Plans that will focus and strengthen the sector going forward. QIPs must be submitted to HQO by April 1, 2013, by all organizations that fall within the following primary care models:

  • Family Health Teams (FHTs);
  • Community Health Centres (CHCs);
  • Nurse Practitioner-Led Clinics (NPLCs); and
  • Aboriginal Health Access Centres (AHACs).

The primary care QIPs will address and focus on three main areas, in line with the priorities of Ontario's Action Plan for Health Care. The areas are:

  • Access
  • Integration
  • Patient-Centredness

The ministry organized governance training sessions to support the board of directors of primary care organizations to enhance their leadership capacity to guide quality improvement. In partnership with HQO, the ministry will support the primary sector with tools and training to further strengthen quality improvement within the sector.

Other Achievements

Drug System Reform

The province continued to make reforms to the drug system to maximize the value the people of Ontario and the government gains from its investment.

Major drug reforms, begun in 2010, lowered the cost of generic drugs by at least 50 per cent to 25 per cent of the brand name drug by eliminating professional allowances. This is saving the province $500 million annually, savings that are being re-invested in the health care system.

The government continued to leverage the more than $4 billion it allocated to drug expenditures in 2012-13 to ensure that the drug program gets better value and that patients get better access to the medications they need. However, Ontario will fund specific drugs only when the best clinical evidence indicates that they benefit patients.

As of January 29, 2013, the province has made the following changes since the Transparent Drug System for Patients Act came into effect in October 2006:

  • 199 new brand drugs have been funded, including new drugs and new indications funded through the Exceptional Access Program. This represents 397 DINs. In addition, 123 drugs/indications have had access increased (i.e., new indications or expansion to general benefit).
  • 74 cancer drugs/indications have been listed (new drugs and expanded indication ‑ under Ontario Drug Benefit, Exceptional Access Program and New Drug Funding Program.
  • 101 new generic drugs, representing 1,535 DINs/strengths, have been listed on the Formulary as benefits.

Other highlights include:

  • Continuing to support access to pharmacy services in rural communities and underserviced areas as well as ensuring that pharmacists in Ontario were being fairly compensated.
  • Reducing and preventing the inappropriate use, abuse and diversion of prescription narcotics and controlled substances, through the development of a comprehensive Ontario Narcotics Strategy.
  • Making changes to the Ontario Drug Benefit (ODB) Formulary, delisting Oxycontin to help ensure it is being used appropriately while still maintaining access to pain management therapies.

Public Health

Over the last nine years, Ontario has made some of the most comprehensive changes to strengthen the province's public health system since the 1980s. These include:

  • Establishing the first stand-alone public health agency – Public Health Ontario (PHO) ‑ provides expert scientific and technical support relating to infection prevention and control; surveillance and epidemiology; health promotion, chronic disease and injury prevention; environmental and occupational health; and health emergency preparedness. Its public health laboratory services support health providers, the public health system and partner ministries in making informed decisions and taking informed action to improve the health and security of Ontarians.
  • Funding 180 new Infectious Diseases Control staff in public health units to monitor and control infectious diseases and enhance the capacity of outbreak management.
  • Developing 14 Regional Infection Control Networks (RICNs) to better integrate infection prevention and control activities across our health system, which have now been transitioned to PHO.
  • Developing and releasing the Ontario Public Health Organizational Standards, 2011. The Organizational Standards reflect existing literature and best practices. The Standards establish the management and governance requirements for all boards of health and public health units. They help promote organizational excellence, establish the foundation for effective and efficient program and service delivery and contribute to a public health sector with a greater focus on performance, accountability and sustainability.
  • Working broadly with health sector stakeholders and other partners to strengthen the ministry and health system capability to prepare for, respond to and recover from emergencies and other critical incidents through: the development of plans to respond to various types of emergencies (such as an influenza pandemic); programs such as emergency stockpiles that enhance response capacity; activities such as training and exercises to maintain emergency preparedness; and the coordination of ministry and health sector responses to emergencies through the Ministry's Emergency Operations Centre.
  • Continuing the implementation of Panorama – a pan-Canadian initiative whose implementation will transform public health in Ontario.  Panorama was designed to revolutionize public health surveillance, improve preparedness for health emergencies, and support improved protection of Ontarians (and Canadians) against emerging and ongoing threats to public health. It will help public health professionals efficiently manage cases and outbreaks of infectious diseases, improve delivery and tracking of immunizations, and better manage vaccine inventories. Through Panorama, a secure provincial immunization registry will be established for all Ontarians, replacing today's paper-based "Yellow Card"

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Table 1: Ministry Interim Actual Expenditures 2012-13 ($)
Operating Expense 46,576,718,160
Capital Expense 1,197,488,900
Total Ministry 47,774,207,060
Staff Strength (as of March 31, 2013) 3,440.0

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