Developing Rural Health Hubs in the

Central East LHIN

Varouj Eskedjian November 2014

Agenda

Central East Community Health Services Integration Strategy

Integration Planning: Northumberland County

Kawartha Lakes/Haliburton County

Haliburton County Integration Transition

HHH Becoming Leaders as a Rural Health Hub

Design and implement a cluster-based service delivery model for Community Support Service, Community Health Centre agencies by 2015 through integration of front-line services, back office functions, leadership and/or governance to:

Improve Client access to high-quality services, create readiness for future health system transformation and,

make the best use of the public’s investment. Hospitals were included in the Northumberland and Haliburton County – City of Kawartha Lakes Processes

Central East LHIN Strategic Aim: Community Health Services Integration Strategy

Our Challenge, Our Opportunity

Coherent, Coordinated, Sustained Integration Strategy

Health Links

Small Rural Hospital Initiative

Community Health

Services Integration

• Improve collaboration between small and rural hospitals and community care to create integrated networks that will: Ensure patient access to core acute care services Ensure collaboration with community services Respond to community needs for post acute care and palliative

services, as appropriate; and Improve the quality and safety of services for patients and ensure

good value for money • Central East $989,900 (2012/13) $709,100 (2013/14)

Pro-rated by combining global budgets of RMH-HHHS & CMH-NHH • Kawartha Lakes-Haliburton $ 965,400 • Northumberland-Campbellford $ 733,600

SRNHTF Objectives & Allocation

1. Improve client access to high-quality services

o Access to consistent and integrated basket of services will improve client and caregiver experience and outcomes

2. Create readiness for future health system transformation

o Create critical mass in governance, management, delivery and IT capacity to enable future growth in community care

3. Make the best use of the public’s investment

o Create opportunities through efficiencies to re-invest in direct client services and reduce latent risk within the sector that jeopardizes quality and access to client services

CHS Integration Strategy - Summary of Benefits

• Facilitated Integration Process Recruitment of dedicated integration facilitators Literature Review Operational review of back office integration opportunities Legal Advice on integration

• Hospital and Community HSP Investments Information Technology and Communication Process review and redesign (e.g. Procurement) Shared Mental Health and IT Leadership Pharmacy Upgrades Diagnostic Imaging QI and Education

Development of Rural Health Hubs!

SRNHTF Enabled

A CHS Toolkit guided the work of the Integration Planning Teams:

• Part 1: Identification of potential integration options

• Part 2: Identification of pros and cons for each option based upon a range of criteria

• Part 3: Risk identification, assessment and mitigation strategies

• Part 4: Identification of high-level estimates of savings for reinvestment and any associated one-time transition costs

• Part 5: Approvals & Transition Planning

Full transition/implementation up to 12 months post approval

CHS Facilitated Integration Toolkit

• Community Care Northumberland

• Campbellford Memorial Hospital

• Campbellford Memorial Multicare Lodge

• Branch 133, Legion Village

• Northumberland Hills Hospital

• Port Hope Community Health Centre

• VON – Ontario Branch

County of Northumberland: Integration Planning Team Organizations

Northumberland County Current State Future State

Scope and Results: Integrate acute, community, primary care, mental health and

long term care services in Trent Hills area – Continue development of Rural Health Hub in Trent Hills – Supportive Housing/ Assisted Living for High Risk Seniors alignment – Develop integrated strategy for Hospice/ Palliative Care and Diabetes – Formalize relationship between Northumberland Hills Hospital and

Port Hope CHC – Create System Transformation Council

Current Status: – Campbellford Memorial Hospital and Campbellford Memorial Multi-

care Lodge have fully integrated back office services (i.e. finance administration, payroll, HR, procurement, IT and Facilities Mgmt)

– Back office integration between Community Care Northumberland and Campbellford Memorial Hospital

Northumberland County CHS Integration Plan

Kawartha Lakes/Haliburton County Integration Planning

• Haliburton Highlands Health Services • VON Canada • Ross Memorial Hospital • Community Care City of Kawartha

Lakes • SIRCH Community Services

Current State – Future State

14

• January 2014 -Integration Transition Team formed Integration transition project plan developed to address:

• Governance, • Communication, • Human Resources • Volunteers • Clients • Finances/Budget and Fundraising • Facilities

• April 2014 - Directional Plan and Transition Team Terms of Reference Approved by all boards

• May 2014 – Sept 30 as Transition Date approved • June 2014 – Central East LHIN Board approved Transition

Plan

Haliburton County Integration Transition Planning

Recommendations for Haliburton County

• Voluntary merger between Community Care Haliburton County and Haliburton Highlands Health Services

• One Entity to deliver hospice/palliative services provided by SIRCH and Adult Day Program services provided by VON.

• Accountability for coordinating Foot Care services would also be transferred from VON to the One Entity.

• SIRCH and VON would continue to exist as ongoing entities, with their own boards, programs and services but would no longer have an Accountability Agreement with the CELHIN

• SIRCH would investigate piloting a new centralized volunteer bureau model (Volunteer Match) that could be used by the One Entity in Haliburton County to recruit, screen, orient and train volunteers

Governance Plan

Integration Plan identified formation of a new Health Services Entity for Haliburton County BUT discussions initiated only with Community Care and HHHS as governance of only these organizations’ governance would be impacted

Two Boards agreed “new entity” would be HHHS and Community Care Haliburton County would wind-down as a corporation following the transfer of the community services on September 30, 2014

To facilitate the Governance Plan, vacancies on the HHHS Board would be held for Community Care Board members wishing to move to the HHHS Board confirmed as of June 26th, 2014 HHHS Annual General Meeting

Formation of Community Advisory Committee to give a “Voice” to providers and recipients of community support services

Integration Planning: Lessons Learned

Leadership critical to success - need positivity, commitment and focus on what is best for community

Project Management Resources should include dedicated support rather than adding stress to operational responsibilities of CEOs and Management Team

Communication/Community Engagement should be done regularly and consistently (never enough) with all stakeholders who would be directly impacted, using a detailed Communication Plan

Post Integration must include: – Maintain Stability through the change but maintain change momentum – Evaluation with all stakeholders (clients, volunteers, staff) – Supporting Staff during Transition and retain and leverage staff skills, support equity

in staff compensation and offer training and development – Involve Local Decision Making and minimize impact on volunteers and local fundraising

LHIN Direction and Support is needed from the LHIN to initiate integration planning, support and ensure success but not to dictate outcome

Current State:

Integration work well underway with CHS Integration process as catalyst for change – setting the stage further discussion and integration

Transitions between home, hospital, and community improving – a collective multi-year investment strategy for SRNHTF developed and re-investment priorities identified

Established Regional Priority Program Focus; chronic disease (diabetes), hospice/palliative care, supported living environments

Progress made on addressing community need within available resources

Final Plans as a strong foundation for continued integration between Hospitals and the Community Sector

Minden Hospital / Hyland Crest Long-Term Care Home

Haliburton Hospital / Highland Wood Long-Term Care Home

Haliburton Highlands Health Services

Community Support Services

Haliburton County Geography

Most northerly region of CE LHIN Large rural geography with dispersed

small population The Haliburton Minden sub-cluster is

made up of four Census Subdivisions defined by Statistics Canada: Algonquin Highlands Dysart and Others Minden Hills Highlands East

Haliburton County Population

Smallest population sub-LHIN region but highest population growth (as % of total population) within the North East Cluster.

Highest % of seniors, and the lowest proportion of individuals 0-24 in Central East LHIN; 28% proportion of seniors 65+ (above 15% LHIN and Ontario averages)

Expected growth - residents aged 65+ are 36% by 2025 and 41% by 2035.

12% proportion of persons aged 75+ is also highest compared to other Sub-LHIN Regions of North East Cluster and Central East LHIN (10%) and Ontario Average (6%).

Haliburton County Population Health Status

Higher rate of arthritis, asthma, diabetes, high blood pressure, cancer, and COPD than both CE LHIN and Ontario averages.

The CE LHIN average is also higher than the Ontario average for all of these chronic conditions with the exception of cancer.

Deaths per 100,000 are higher in Haliburton County and the North East Cluster for all conditions for which data is available on the CE LHIN, and Ontario.

– This includes from cancers, circulatory diseases, ischaemic heart diseases and respiratory diseases.

Furthermore, while residents of the region have a self-perceived feeling of good health that is in line with the CE LHIN average, the average life expectancy is below both the CE LHIN and Ontario averages at birth and age 65.

HHHS Strategic Plan 2014 - 2017

HHHS Mission

Haliburton Highlands Health Services, working with partners and accountable to our community, promotes wellness and provides access to essential, high quality health services, including: Primary Care Hospital (Acute Inpatient and Emergency Care) Long-Term Care End-of-Life Care Mental Health and Addictions Services Community Support Services.

HHHS Vision

Our Vision is to be:

Leaders in innovative rural health care.

HHHS Values

Compassion

Accountability

Integrity

Respect

Rural Health Hub - Model

Defining a Rural Health Hub

OHA working definition of a Local Health Hub “ a local integrated health service delivery model where most, if not all sectors of the health system are formally linked in order to improve patient sectors of the health system are formally linked in order to improve patient access, and a single funding envelope is provided to a fund-holder organization to manage the health of the local population” Core services requirements to be provided by Local Health Hub include:

– Emergency and Inpatient Care – Comprehensive Primary Care – Home and Community Long-Term Care – Mental Health and Addictions

Would also need to partner with local municipalities with Ambulance Services and with Public Health

Expectation to pursue partnerships with local health and human service providers to ensure that local residents have access to a comprehensive range of treatment support and prevention services

HHHS Becoming a Leader as a Rural Health Hub

Structural Integration – Vertically-integrated; Continuum of hospital, community and LTC Services – Horizontally integrated: strategic relationship with Ross Memorial Hospital – Not an end but means to further enhance quality and access and save $$

Enhance Quality and Access: Leverage integrated delivery structure as a platform – Across HHHS

End of Life Care Physiotherapy & Falls Prevention, Health Promotion and Illness Prevention Integrated QIP for Hospital / LTC / Community Support Services Diagnostics

– With local provider partners: FHT, CCAC, EMS, Health Links Rural Gain Community Paramedicine Central East CCAC – office within HHHS

HHHS Becoming a Leader as a Rural Health Hub

Strategic Alliance with Ross Memorial Hospital – Explore further clinical opportunities

Mental Health and Addictions Ambulatory Chronic Disease Management (Health First)

– Explore further back-office opportunities Finance/HR

eHealth as enabler to integrated service delivery – Common HIS: LHIN-wide/ GTA / Province – Network Infrastructure/ Shared IT: Regional with RMH – Local connectivity: with FHT, EMS, CECCAC – mHealth Strategy: for personalized care in community

HHHS Becoming a Leader as a Rural Health Hub

Other Partnerships – Partnerships with CE LHIN and with Larger Tertiary Centres

Common HIS Pilot Projects (e.g. UHN/OTN remote patient monitoring)

– Partnerships with Local Agencies and Municipalities Haliburton County Service Providers Network Seniors housing and retirement homes Transportation infrastructure

Partners with Haliburton County residents – Community Advisory Committee – Community Engagement and Communication Plan

HHHS Becoming a Leader as a Rural Health Hub

Long Term Vision (5-10-15 year timeframe) Guided by Master Program / Master Plan to be developed in broad

consultation with internal and external stakeholders Determine demographics of population in longer term timeframe and

determine Service Needs, particularly growing numbers of seniors and frail elderly

Assess capability of facilities in Minden and Haliburton to delivery longer term Master Plan

Reconfigure Minden and Haliburton Sites? – Seniors Site with expanded Aging in Place options and services and

enhanced Primary / Urgent Care – Acute Hospital Site with consolidated ED and expanded diagnostics – Transportation infrastructure across communities

Leaders in innovative rural health care.