October 16th, 2018 Toronto Central LHIN HSP Education Webinar MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENTS (MSAA) 2019-20 CAPS, Schedules and Indicators Education Session October 16th, 2018 Toronto Central LHIN HSP Education Webinar Neil

Agenda Multi-Sector Service Accountability Agreements (MSAA) 3 MSAA Governance Structure 6 Toronto Central LHIN’s Performance Management Framework 8 Planning for 2019-20’s MSAA 11 Changes to the 2018-19 CAPS 13 Additional Resources & Education for the CAPS Refresh 15 Important* Considerations when Completing CAPS Refresh 16 CAPS & MSAA Schedules Timelines 17 Appendices: 2019-20 MSAA Schedules Overview 20 2019-20 MSAA Indicators Overview 26 Contact Information and MSAA Advisory Committee membership 48 Neil

1. The Multi-Sector Service Accountability Agreement Neil

Some key articles include: XXX HSP Articles set out the terms and conditions to enable the provision of services to the local health system by HSPs Some key articles include: Provision of services (e.g. HSPs cannot limit services by geography, HSPs are required to notify LHINs where services are being reduced, started, expanded, etc) Repayment & Recovery of Funding (LHIN can reconcile unspent funding, forecasted surpluses, etc) Performance (Right to request performance meetings and develop Performance Improvement Plans with HSPs, etc) Provincially negotiated between the 14 LHINs and selected stakeholders (e.g. HSP Leadership, AMHO, CMHA)

Submission of HSP Supplemental (replaced Schedule A) XXX HSP Schedules include: Submission of HSP Supplemental (replaced Schedule A) LHIN funding (Schedule B) Reporting deadlines (Schedule C) including: SRI/Quarterly Reports Audited Financial Statements Annual Reconciliation Reports French Language Services Report Declaration of Compliance Directives, Policies, Guidelines applicable to HSP sector (Schedule D) Clinical/Service Volumes, Performance Indicators and Local Obligations (Schedule E)

2. MSAA Governance Structure

MSAA Governance Structure Comprehensive Consultation through Multiple Tables MSAA Advisory Committee MSAA Indicators Work Group (Determines Indicators to be included in MSAA) MSAA Planning & Schedules SRI Reporting Forms Work Group (CAPS templates) MSAA Legal Counsel Support: LHIN Legal Services Branch MSAA Secretariat Support: Health Shared Services Ontario Local MSAA Implementation: MSAA LHIN Leads

3. Toronto Central LHIN Performance Management Framework Neil

Toronto Central LHIN Performance Management Framework Toronto Central LHIN currently measures and evaluates HSP performance through several performance and reporting domains: Service activity and volumes, including key performance targets Financial health Local obligations (which may reflect activity or volume requirements) Adherence to Schedule C reporting requirements (including both timeliness and accuracy) Each of the four domains above are considered and each organization’s performance is assessed using a four-level Performance Management Framework (slide 8). In evaluating performance, we use a combination of quantifiable reported data through SRI reporting and LHIN-led reporting initiatives, and qualitative information collected in consultation with the performance management leads. As such, timeliness and accuracy of CAPS and Quarterly reports is key. Neil

Performance Management Framework Level Assessment Description 1 Minor to no concerns in both the performance and reporting domains, and Met or exceeded 75% or more of key performance indicators 2 Isolated or one-time concerns in one or two performance domains, and/or Isolated or one-time concerns identified in reporting domain, and/or Met 51 - 74% of performance indicators 3 Repeated or concurrent concerns in one or two performance domains, and/or Isolated or one-time concerns in multiple performance domains, and/or Repeated concerns identified in reporting domain, and/or Met 25 - 50% of performance indicators 4 Ongoing, unaddressed concerns in multiple performance domains, and/or Ongoing, unaddressed concerns identified in reporting domain, and Met less than 25% of performance indicators Neil

4. Planning for 2019-20’s MSAA Neil

Planning for 2019-20’s MSAA 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 Mike

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 Confirmed that Community Paramedicine (72 5 30 80 05) has been added to the CAPS and quarterly templates Mike

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 populate 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 Mike

Additional Resources & Education for the CAPS Refresh HSPs should first utilize the below resources when completing the 2019-2020 CAPS, and if they still require support, please reach out to AccountabilityPlanning@tc.lhins.on.ca or your Performance Lead (slide 48.) 2018-19 CAPS Completion Guide and CAPS Guidelines contain important information to assist HSPs in completing the CAPS process. 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/ All resources related to CAPS will be uploaded by EOD 19th Oct, to Toronto Central LHIN’s website at http://www.torontocentrallhin.on.ca/forhsps/accountabilityagreements/msaa/caps.aspx All data standards inquiries for all sectors should be directed to HDBDS@ontario.ca. For directions on how to direct inquiries, please access the PDF embedded here Mike

Important Considerations for 2019-20 CAPS & MSAA CAPS and Q2: Identified Issues There have been some identified CAPS/Q2 template issues More details including workarounds are outlined in the FAQ document here Updated contact for hospital MSAAs/CAPS- Luciano.Veta@tc.lhins.on.ca Community Rate Harmonization Goal: To establish consistent service definitions and units of measure for Functional Centres (FC) Multi-year initiative starting this fiscal, focusing on a sub-set of FCs HSPs delivering the services associated with these FCs will be engaged in advance and during CAPS negotiations One-time funding volumes are *not* to be included in CAPS Reported through Toronto Central LHIN Funding Management Tool (FMT) www.tclhin.ca For questions or issues related to using FMT, contact TCLHIN.Reporting@lhins.on.ca Community Health Centres: Supplemental Indicators Starting 2019-20, Toronto Central LHIN is requesting that all CHCs begin reporting on non-insured clients Revision of Local Obligations for 2019-20 Data errors Mike

5. CAPS & MSAA Timelines Neil

CAPS & MSAA Timelines HSPs received a communication on October 10th with key timelines for planning submissions Timelines are also available on our website at: http://www.torontocentrallhin.on.ca/forhsps/accountabilityagreements.aspx Activity Community HSPs* (MSAA) Hospitals* (HSAA) Long-Term Care Homes* (LSAA) Toronto Central LHIN will conduct local CAPS, HAPS and LAPS (Planning Submissions) Schedules and Indicators Education webinar for HSPs. October 15th – 19th, 2018 Planning Submissions (CAPS/HAPS) open in the Self Reporting Initiative (SRI) and (LAPS) on the Long-Term Care Home Portal at https://hsimi.ca/LTCHome   HSPs can start to complete their submissions. October 12th, 2018 CAPS/HAPS (and Q2) templates are being revised as of October 9th, any HSPs who have completed their submissions prior may have to use a new template. Formal 60 Day LHSIA Notices Issued to HSPs stating SAAs are being negotiated. November 15th, 2018 Draft CAPS and HAPS must be submitted to SRI and, draft LAPS on the Long-Term Care Home Portal at https://hsimi.ca/LTCHome for Toronto Central LHIN review. November 19, 2018 Engagement with HSPs on submissions, local obligations, 2018/19 risks, opportunities and negotiations for 19/20 (face to face or phone). November 2018 -January 2019 Final date for completion of LHIN negotiations with HSPs to review Planning Submissions and negotiate proposed H-M-L-SAA targets and content for schedules. Up to February 15, 2019 Approved CAPS/HAPS submitted to SRI and LAPS to the Long-Term Care Home Portal at https://hsimi.ca/LTCHome for Toronto Central LHIN to create agreements. (HSPs are required to manage their own internal approval processes; as of end of business this day we will assume most recent submission has received internal approvals). February 15, 2019 Final date for H-M-L-SAA documents and Schedules to be sent to HSPs from LHIN. Up to February 28, 2019 Final date for execution of signed H-M-L-SAAs. March 31, 2019 2019/20 H-M-L-SAAs come into effect. April 1, 2019 Laura

Questions? Laura

Appendix 1. 2019-20 MSAA Schedules Overview Neil

2019-20 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 (Not applicable to Toronto Central LHIN HSPs, has been replaced by HSP Supplemental which can be found on our website at: http://www.torontocentrallhin.on.ca/forhsps/Suppl ementalDataCollection.aspx 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. Neil

2019-20 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 (This template is not applicable to Toronto Central LHIN, funding requests are submitted through Health System Improvement Pre-Proposals. More info at http://www.torontocentrallhin.on.ca/forhsps/hsip.aspx 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 Neil

Recommended Changes to 2019-20 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. Neil

Recommended Changes to 2019-20 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 Neil

Recommended Changes to 2019-20 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 Neil Note: schedules will be “re-lettered” prior to final release

Appendix 2. 2019-20 MSAA Indicators Overview Laura

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 Laura

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 Laura

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.                   Laura

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* Elizabeth *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. Elizabeth

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. Elizabeth

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 Elizabeth

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) Elizabeth

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’) Elizabeth

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) Elizabeth

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 Elizabeth

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

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

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 Elizabeth

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 Number of new patients Number of registered clients Specialized care Supervision of students Third next available appointment (3NAA) Non-insured clients** (Toronto Central LHIN is requesting that all CHCs begin reporting on non-insured clients from 2019-20) 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. Elizabeth

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

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 Elizabeth

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

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

Reminder: Principles for Selecting Local Obligations ESSENTIAL CRITERIA Strategic Alignment: The proposed LHIN-specific obligation reflects the system perspective and important goals or aspects of the regional or local health system. It aligns with one or more provincial and/or LHIN system imperatives, and with one or more health system outcome objectives.  Focus on Integration: The proposed LHIN-specific obligation enables greater integration within and across health sectors at the sub-region or LHIN level, with an emphasis on seamless transitions in care for patients.  Focus on Improvement: The proposed LHIN-specific obligation focuses on matters related to system outcomes, provider-specific performance, and quality improvement. Laura *Note: The proposed LHIN-specific obligation is distinct from existing requirements and accountabilities.

Reminder: Purpose of LHIN Local Obligations (Schedule E3a) Strategic Alignment: The proposed LHIN-specific obligation reflects the system perspective and important goals or aspects of the regional or local health system. It aligns with one or more provincial and/or LHIN system imperatives, and with one or more health system outcome objectives.  Focus on Integration: The proposed LHIN-specific obligation enables greater integration within and across health sectors at the sub-region or LHIN level, with an emphasis on seamless transitions in care for patients.  Focus on Improvement: The proposed LHIN-specific obligation focuses on matters related to system outcomes, provider-specific performance, and quality improvement. *Note: LHIN-specific obligations are distinct from existing requirements and accountabilities and are considered in the Performance Management Framework. Laura

Performance Management Team Appendix 3: Toronto Central LHIN Contact Information Performance Management Team Name Role Email Phone Sheila Banks-Switzer Director, Performance Management sheila.banks-switzer@tc.lhins.on.ca   416-217-3820 ext 2596 Luciano Veta Manager, Contracts and Performance, Hospital MSAAs luciano.veta@tc.lhins.on.ca ext 3223 Andrea Tsuji Senior Consultant, MH&A andrea.tsuji@tc.lhins.on.ca ext 3378 Laurent Tyers Senior Consultant, SPO laurent.tyers@tc.lhins.on.ca ext 2508 Nello Del Rizzo Senior Consultant, CSS nello.delrizzo@tc.lhins.on.ca ext 3224 Shama Umar Senior Consultant, Primary Care shama.umar@tc.lhins.on.ca ext 3217

Appendix 3: MSAA Advisory Committee Member Position Organization Scott McLeod (Co-chair) CEO CW LHIN Chantale LeClerc (Co-chair) President and CEO CH LHIN 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 3: 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