MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENTS (MSAA) 2019-20 CAPS, Schedules and Indicators Education Session September 17, 2018

Agenda MSAA Governance Structure Context CAPS Changes to the 2018-19 CAPS CAPS Narrative Completion CAPS Narrative Submission Additional Resources CAPS Demo 2019-20 MSAA Schedules Overview 2019-20 MSAA Indicators Overview CAPS & MSAA Schedules Timelines

MSAA Governance Structure Comprehensive Consultation through Multiple Tables MSAA Advisory Committee MSAA Indicators Work Group MSAA Planning & Schedules SRI Reporting Forms Work Group MSAA Legal Counsel Support: LHIN Legal Services Branch MSAA Secretariat Support: Health Shared Services Ontario Local MSAA Implementation: MSAA LHIN Leads

Context The MSAA Advisory Committee is working toward a new three year agreement effective from April 1, 2019 to March 31, 2022. To support this new agreement the MSAA indicators and schedules have been refreshed and updated: A (Description of Services) B (Service Plan) C (Reports) D (Directive Guidelines and Policies) E (Performance) (MSAA Indicator Work Group) F (Project Funding Template) G (Compliance) *Note that final approval from the CEO Council is upcoming, so changes may occur

CAPS

CAPS Changes for 2019-20 Removed 4 Functional Centres that changed to Account Headers effective April 1, 2018 72 5 10 40 COM Clinics/Programs - Therapy Clinic Removed 72 5 10 50 COM Clinics/Programs – Chronic Disease Clinic 72 5 50 45 COM Health Prom/Educ. & Com Dev- Personal Health and Wellness 72 5 50 35 COM Health Prom/Educ. & Com Dev - COM Chronic Disease Education, Awareness and Prevention Added 6 Functional Centres (2 New, 4 Previously reported in one of the F/C’s above that became Account Headers in April 2018 New 72 5 10 50 50 Clinics/Programs - Chronic Disease – Cardiac Rehabilitation Clinic 72 5 50 45 05 Personal Health and Wellness – General Existing in OHRS (New to CAPS reporting) 72 5 50 45 10 Personal Health and Wellness – Mental Wellness, Personal Health Practices and Coping Skills 72 5 50 45 20 Personal Health and Wellness – Oral Health 72 5 50 45 30 Personal Health and Wellness – Healthy Child 72 5 50 45 40 Personal Health and Wellness – Youth Development

CAPS Changes for 2019-20 Edit Checks Added On the Service Selection Screen when a Functional Centre is selected it must have a corresponding TPBE selected to identify the program funding that the service applies to. If a provider does not select a functional centre on the Service Selection screen but completes planned amounts on the Act_Summary screen for that functional centre, an error will be flagged. Financial and Service Activity reporting Pages Added columns for Budget for 2020-21 and 2021-22. These columns are not locked but do populated from the input into the Budget 2019-20 column E Variance calculations have been added for each line to highlight changes between the 2018-19 CAPS budget (original) and the 2019-20 CAPS budget (proposed). The HSP specific view on the Activity Page now has two options: Show the HSP specific Functional Centres that they have selected along with the “Mandatory” services Show the HSP specific Functional Centres that they have selected along with all of the service lines. This option is available where changes to the Mandatory lines have occurred after the report was finalized. Main Menu Added a calculation in Column F that flags any Changes to the budget from 2018-19 CAPS The “Verify Edit Checks” link will show an û to the left of the link when there are any outstanding edit checks that have not been resolved on the Edits worksheet. Colour coded the links to differentiate between General, Financial, and Activity Moved the Financial Summary link to the top of the Financial list

CAPS Narrative Completion The CAPS narrative has been redesigned to accommodate more detailed collection of data relating to the services the Health Services provide in their areas Instructions for completion are contained in the new CAPS Planning Narrative Guide 2019-20 The information provided in the CAPS narrative will not be included in the final MSAA legal agreement. A more detailed presentation and supporting education documents are provided under separate cover

CAPS Narrative Submission The CAPS Narrative should be submitted with the CAPS on SRI under the “Additional Documents” tab. The CAPS Narrative should be submitted at the time that CAPS is submitted (Nov 16, 2018) If an individual LHIN chooses to receive the CAPS Narrative via email, be sure that the provider adds a password (to open) to the Excel file (Recommended: mynarrative). Otherwise the macros will be disabled by the LHIN email system

Additional Resources & Education for the CAPS Refresh The 2018-2019 CAPS Completion Guide contains important information to assist HSPs in completing the CAPS process. HSPs should refer to the Completion Guide when completing the 2019-2020 CAPS. The CAPS Guidelines have been updated for 2019-20 to provide additional information when completing the CAPS.

Additional Resources & Education for the CAPS Refresh The new CAPS narrative has a recorded training webinar: HSP Completion: https://ali.health.gov.on.ca/p32lkvnvizc/ The CAPS has a recorded webinar that mirrors the written completion guide: https://ali.health.gov.on.ca/p9eiv0i80rc/

CAPS Demo Detailed step by step training is available in the CAPS completion guide and through the recorded webinar at: https://ali.health.gov.on.ca/p9eiv0i80rc/

Schedules

2018-19 MSAA Schedules Schedule Title Description A A1. Description of Services A2. Population & Geography Describes the services delivered by the HSP and the HSP’s client populations and geography served B B1. Total LHIN Funding Service Plan B2. Clinical Activity – Summary Describes the financial and statistical status of the HSP C Reports Identifies and sets due dates for HSP reporting D Directives, Guidelines, Policies & Standards Identifies applicable MOHLTC policies.

2018-19 MSAA Schedules (cont’d) Title Description E 1. Core Indicators Identifies indicators, standards and local performance requirements 2a. Clinical Activity Detail 2b. CHC Sector Specific Indicators 2c. CMH&A Sector Specific Indicators 2d. CSS Sector Specific Indicators 3a. Local Indicators & Obligations F Project Funding Agreement Template Template used for funding projects that are distinct from anything else; a unique project that has nothing to do with the existing services within the SAA G Declaration of Compliance Form completed by the HSP Board of Directors to declare that the HSP has complied with the terms of the Agreement

Recommended Changes to 2018-19 MSAA Schedules cont’d Rationale A Removed and incorporated into a separate CAPS Narrative The information captured is used for LHIN planning and not relevant to accountability B B1: Total LHIN Funding - added applicable dates for 2019-20 Updated to reflect 2019-20 B2: Clinical Activity Summary The information is redundant as it is a summary of other information collected C - CHC Added applicable reporting dates for 2019-20 Updated to reflect applicable 2019-20 reporting periods Community Engagement and Integration Activities Reporting added Was added to the MSAA template in 2018- 19 C - CMHA Due dates for the Common Data Set for Community Mental Health Services (CDS-MH) have been removed The ministry has deferred the submission of CDS-MH data starting in fiscal year 2018-19. See footnote note in schedule.

Recommended Changes to 2018-19 MSAA Schedules cont’d Rationale C - CMHA & CSS Added applicable reporting dates for 2019-20 Updated to reflect applicable 2019-20 reporting periods Community Engagement and Integration Activities Reporting added Was added to the MSAA template in 2018- 19 C - CSS D - CHC Added additional directives, polices and guidelines Relevant to sector D - CMHA & CSS D - CSS

Recommended Changes to 2018-19 MSAA Schedules cont’d Rationale D - CMHA Added additional directives, polices and guidelines Relevant to sector E See indicator slides F No change Section 11 of the Public Sector Compensation Restraint to Protect Public Services Act, 2010 is still applicable G Added applicable period Updated to reflect the applicable period Note: schedules will be “re-lettered” prior to final release

Indicators

Indicator Work Group Focus & Approach The work group will be completing an in-depth review of the indicators, technical specifications and target setting guidelines It aims to deliver a slate of meaningful and measureable indicators that reflect the patients’ continuum of care, promotes patient centred discussions among all the sectors and in which each sector can recognize their contribution Recognizing that the work will go beyond the deadlines for the usual refresh process the group has expanded its work plan and will continue its work through the remainder of the fiscal year

Approach to the Technical Specifications A technical specification (tech spec) document is developed each year. The tech spec specifies indicator definitions, calculations, reporting periods, and other technical information The work group will be updating the tech spec to more clearly describe and define the indicators, and will add a section that identifies the CAPS location for ease of reference

Approach to Indicator Targets A target setting document is developed each year that provides performance target and corridor setting methodology to guide consistency and commonality across the LHINs and health service providers (HSPs) when establishing targets. The performance target and corridor-setting guideline accompanies the indicator technical specification document. Note: Performance targets and corridors are only established for performance indicators.                  

Approach to Indicators SAA indicator categories have be updated to reflect recommendations from the Data and Performance Work Stream As such, indicator decisions have been approached with these new categories in mind Current Categories Performance Explanatory Developmental New Categories Performance Monitoring Explanatory Developmental Future* *Note: Future Indicators would not be included in the SAA

SAA Indicator Categories Indicator Type Criteria Performance A measure of HSP performance for which a Performance Target is set. A performance indicator is a valid, feasible measure of HSP performance over which the HSP has control or substantial influence. Monitoring A measure of HSP performance for which no Performance Target is set. A monitoring indicator is a valid, feasible measure of HSP performance over which the HSP has control or substantial influence. Explanatory A measure that is connected to and helps to explain performance in a Performance Indicator or a Monitoring Indicator. An Explanatory may or may not be a measure of the HSP’s performance. No Performance Target is set for an Explanatory Indicator.

Indicator Categories cont’d Indicator Type Criteria Developmental A measure of local health system performance that requires development due to factors such as the need for methodological refinement, testing, consultation, or analysis of reliability, feasibility, and/or data quality. These indicators, once developed, are expected to be moved to either the Performance or the Monitoring category. Future A measure of local health system performance that requires development or modification of datasets or data collection processes to allow the measure to be reported. These measure may also requires work to clearly define the indicator and outline how it would be calculated. Once developed, these measures should be reviewed for placement in one of the accountability levels or for potential inclusion in the LHIN Senior Management dashboard, or for rejection.

Summary of Indicators Core Indicators Performance Monitoring Explanatory Community Health Centres (CHC) Indicators Developmental Community Service Sector (CSS) Indicators Community Mental Health & Addiction (CMHA) Indicators

Core (All Sectors) Performance Indicators Fund type 2 balanced budget Proportion of budget spent on administration Variance forecast to actual expenditures (moved to Monitoring) Percentage total margin Service activity by functional centre Variance forecast to actual units of service (moved to Monitoring)

Core (All Sectors) Performance Indicators (cont’d) Number of Individuals Served (by functional centre) (name changed from Number of individuals served) ALC Rate (move to ‘Monitoring’)

Core (All Sectors) Monitoring Indicators (NEW INDICATOR CATEGORY) Variance forecast to actual expenditures (moved from Performance) Variance forecast to actual units of service (moved from Performance) ALC Rate (moved from Performance)

Core (All Sectors) Explanatory Indicators Cost per unit of service (by functional centre) Cost per individual serviced (by program/service/functional centre) Client experience Percentage of Alternative Level of Care (ALC) days

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

Community Support Services Developmental Indicators Average number of days waited for first service (by functional centre)

Community Health Centres Performance Indicators Cervical cancer screening Colorectal Screening rate Inter-professional diabetes care rate Influenza vaccination rate Breast cancer screening rate Retention Rate (for NPs and GPs Access to primary care

Community Health Centres Explanatory Indicators Client satisfaction – Access Clinical support staff per primary care provider Interpretation Exam rooms per primary care provider New grads/new staff Non-Primary Care activities

Community Health Centres (cont’d) Explanatory Indicators Number of new patients Number of registered clients Specialized care Supervision of students Third next available appointment (3NAA) Non-insured clients Travel time (NEW) This indicator calculates the percentage of total time GP, NP, PA, RN and RPN spend travelling for the purpose of direct service delivery to clients. High risk urban population (NEW) This indicator identifies Community Health Centres who provide services to a high risk urban population.

Community Health Centres Developmental Indicator CHC clients hospitalized for Ambulatory Care sensitive conditions (ACSC)

Community Mental Health & Addiction Explanatory Indicators Repeat unscheduled emergency visits within 30 days (for mental health conditions; for substance abuse conditions) Average number of days waited from referral/application to initial assessment complete Average number of days waited from initial assessment complete to service initiation

Community Mental Health & Addiction Developmental Indicator Ontario Common Assessment of Need (OCAN)

Community Mental Health & Addiction Future Indicator (NEW CATEGORY) Ontario Perception of Care (OPOC) Tool for MHA (NEW)

MSAA Timelines Activity Target Dates Pan-LHIN MSAA Lead Education (CAPS, Indicators & Schedules) September 17, 2018 (Complete) CAPS 60 Day Issuance Notice to HSP’s September 30, 2018 LHINs Complete Local HSP CAPS Education September 18 - 28, 2018 CAPS Launch in SRI for HSPs October 1, 2018 Completed CAPS refresh submitted through SRI to LHINs October 1 – November 16, 2018 Send MSAA LHSIA Notices to HSPs Fall 2018 LHIN review of CAPS refresh, consultations on MSAA refresh indicators, population of Schedules, and final MSAA Schedule amendments November 19, 2018 – January 31, 2019 LHIN Boards to endorse MSAA Template (2/3 majority required) December 1 – 31, 2018 LHIN Analysis, Final Negotiations of Indicator Targets and Population of Schedules January 1 – 31, 2019 HSP Board approves CAPS Pan-LHIN Community Lead Education (eForms) Early January 2019 Final MSAA template and Schedules sent to Community HSPs for Board approval February 1 - 28, 2019 HSP-signed MSAAs returned to the LHIN by March 15, 2019 2019-2022 MSAA comes into effect April 1, 2019

Appendix 1: LHIN Contact Information LHIN Name Email Secondary Contact and Email ESC Jean-Francois Gauthier jeanfrancois.Gauthier@lhins.on.ca stephanie.harper@lhins.on.ca SW Amina Sogolj amina.sogolj@lhins.on.ca WW Blair Philippi blair.philippi@lhins.on.ca jim.borysko@lhins.on.ca / tiffany.britten@lhins.on.ca HNHB Ashley Bolduc ashley.bolduc@lhins.on.ca anne.nelson@lhins.on.ca CW Neil McIntosh Neil.McIntosh@lhins.on.ca MH Jeanny Lau jeanny.lau@lhins.on.ca TC Nello Del Rizzo nello.delrizzo@tc.lhins.on.ca andrea.tsuji@lhins.on.ca C Edin Wong edin.wong@lhins.on.ca   CE Michelle Nurse michelle.nurse@lhins.on.ca tunde.igli@lhins.on.ca SE Joe Sherman Joe.sherman@lhins.on.ca tao.jiang@lhins.on.ca CH Colleen Taylor colleen.taylor@lhins.on.ca eric.partington@lhins.on.ca NSM Jenna Mitchell Jenna.Mitchell@lhins.on.ca allan.marion@lhins.on.ca NE Barry Lajeunesse barry.lajeunesse@lhins.on.ca NW Kevin Holder kevin.holder@lhins.on.ca Eforms Kelvin Luk kelvin.luk@lhins.on.ca

Appendix 2: MSAA Advisory Committee Member Position Organization Scott McLeod (Co-chair) CEO CW LHIN Chantale LeClerc (Co-chair) President and CEO Soldier's Memorial Hospital Adrianna Tetley Alliance for Healthier Communities (The Alliance) (Formerly Association of Ontario Health Centres (AOHC) Debbie St John-de Wit Executive Director Seaway Valley CHC (The Alliance member rep) Camille Quenneville Chief Executive Officer Canadian Mental Health and Addictions (CMHA) Ontario Steve Lurie CMHA Toronto Gail Czukar Addictions & Mental Health Ontario (AMHO) Mohammed Badsha COO Reconnect Mental Health Services (AMHO member rep) Shilpi Majumder Director of Public Policy AdvantAge Ontario Soo Ching Kikuta Director, Resident Care & Services City of Toronto (AdvantAge Ontario member rep) Patrick Boily Manager, Policy and Stakeholder Engagement Ontario Community Support Services Association (OCSA) Jason Lye National Director Independent Living Services, March of Dimes Canada (OCSA member rep) Kavita Mehta Association of Family Health Teams of Ontario (AFHTO) Dawn Tymianski Interim CEO Nurse Practitioners’ Association of Ontario (NPAO)

Appendix 3: PSWG Membership Position Organization Neil McIntosh (Co-lead) Director, Performance and Accountability CW LHIN Sue Turcotte ( Co-lead) Director, Performance, Contracts and Allocation C LHIN Jeanny Lau Lead, Health System Performance MH LHIN Jean-Francois Gauthier Performance ＆ Finance Analyst ESC LHIN Kelvin Luk Senior Analyst, Decision Support Performance Contracts Allocations Josh Clark Financial Analyst Performance & Accountability SW LHIN Jason Lye National Director Independent Living Services, March of Dimes Canada John Jordan Executive Director Lanark Renfrew Health and Community Services Joshua Murray Manager, Policy and Research AMHO Aimee Juan Manager of Addiction Services Thunder Bay Counselling Centre Shilpi Majumder Director of Public Policy AdvantAge Ontario Matilda Kress Community Program Manager Region of Waterloo Ivan Lewis Director of Finance and Corporate Services CMHA Toronto Gary Thompson Team Lead MOHLTC Michelle Albornoz Data Management Specialist

Appendix 4: IWG Membership Position Organization Laura Salisbury (Co-lead) Director, Health System Performance, Funding and Contract Management MH LHIN Elizabeth Salvaterra (Co-lead) Pan-LHIN Lead LHIN Renewal Kevin Holder Performance, Funding and Contract Management Specialist, Corporate Services NW LHIN Tiffany Britten Manager, Contracts & Accountability Waterloo Wellington LHIN Peng Liu Senior Finance Services Manager Ontario March of Dimes Sue Hillis Executive Director Dale Brain Injury Services Shilpi Majumder Director of Public Policy AdvantAge Ontario Heather Mihichuk Program Manager Jasper Place, Thunder Bay Laurie Fors Rachel Arbour Regional Decision Support Specialist, Northern Region Centre de santé communautaire Sudbury-Est (Sudbury East CHC) Steve Lurie CMHA Toronto Jesse Auguste Policy Analyst Addictions & Mental Health Ontario (AMHO) Domenic Della Ventura Team Lead, Performance & Accountability MOHLTC, LLB Nam Bains Manager - Capacity Planning and LHIN Support MOHLTC Ying Jiang Senior Policy Advisor (Acting) MOHLTC, HAB Winnie Chan Health Analyst, Measurement and Decision Support Maria Pesce Manager (Acting) Naushaba Degani Manager, Research Methods Health Quality Ontario