COMMUNITY ACCOUNTABILITY PLANNING SUBMISSIONS (CAPS) & MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENTS (M-SAA) 2013/14 REFRESH Education Session October 2012

Agenda: Context Timelines CAPS Guidelines CAPS Components Principles Guiding the 2013/14 CAPS & M-SAA Refresh Planning for the 2013/14 CAPS & M-SAA Refresh CAPS Components Performance Indicators M-SAA Refresh Content - Schedules Health Service Providers Responsibilities Next Steps Discussion The contents of todays webinar includes an overview of the 2011-14 M-SAA Refresh Process that includes the Context, Timelines, then it will transition into the introduction of the 2013-14 CAPS guidelines, user guide and a CAPS DEMO upon completion of the demo an overview of the Performance indicators and the M-SAA refresh content will be reviewed. The conclusion of todays contents will describe the Health Service Providers responsibilities, look at the next steps and then questions will be fielded.

Context Why a 2013/14 CAPS and M-SAA Refresh? The LHINs and community based Health Service Providers (HSPs) entered into an M-SAA for a three year period effective April 1st 2011 to March 31st 2014 At that time, the year three (2013/14) financial, service activity and performance indicator Schedules were indicated as “to be determined (TBD)”. Community Health Centre (CHC), Community Care Access Centre (CCAC), Mental Health and Addiction (MH & A) and Community Support Service (CSS) sectors need to complete a refresh of the 2013/14 Community Annual Planning Submission (CAPS) for the final year of the 2011-14 M-SAA. As we know it is a requirement of the Local Health System Integration Act, 2006 that Local Health Integration Networks have a service accountability agreement (SAA) in place with each health service provider (HSP) that it funds. The LHIN and community based Health Service Providers entered into a three year M-SAA effective April 1 2011 through to March 31, 2014. At that time, the year three (2013/14) financial, service activity and performance indicator Schedules were indicated as “to be determined (TBD)”. We are now at the TBD therefore the Community Care Access Centre (CCAC), Mental Health and Addiction (MH & A) and Community Support Service (CSS) sectors need to complete a refresh of the 2013/14 Community Annual Planning Submission (CAPS) for the final year of the 2011-14 M-SAA.

2013/14 CAPS & M-SAA Refresh Development Structure CCAC representation MH&A MOHLTC M-SAA Steering Committee CSS CHC LHIN LHIN Legal Health System Indicator Steering Committee As you will denote in this slide it depicts the developmental structure process of the 2013-14 CAPS M-SAA refresh process. The schematic demonstrates representation from all sectors. CAPS / M-SAA Refresh Working Group

Context Additional Resources for the 2013/14 CAPS The 2013/14 CAPS & M-SAA Refresh Guidelines (“Guidelines”) contain important background and sector specific information to assist HSPs in completing the CAPS process. The 2013/14 CAPS Technical User Guide (“User Guide”) contains step by step instructions on how to complete the CAPS excel based reporting tool. All HSPs will be provided with the CAPS forms (excel based reporting tool), Guidelines and Technical User Guide on or before October 15th 2012. ***HSPs should refer to both the Guidelines and User Guide when completing the 2013/14 CAPS.*** The resources available to you for the 2013/14 CAPS are as follows: The 2013/14 CAPS & M-SAA Refresh Guidelines (“Guidelines”) this document contains important background and sector specific information to assist HSPs in completing the CAPS process. The 2013/14 CAPS Technical User Guide (“User Guide”) this document contains step by step instructions on how to complete the CAPS excel based reporting tool. All HSPs will be provided with the CAPS forms (excel based reporting tool), Guidelines and Technical User Guide on or before October 15th 2012. When completing the 2013/14 CAPS please refer to both the Guidelines and the User Guide for assistance

Timelines Completing the 2013/14 CAPS & M-SAA refresh Projected Timelines Oct 1-14 HSP 2013 CAPS & M-SAA refresh webinar/education session. Oct 15 LHINs to email 2013/14 CAPS file to HSPs.This will be done via email NOT SRI. Nov 30 Completed HSP Board approved 2013/14 CAPS submitted to the LHIN HSP Boards must have approval without indicators. Document to reflect date of board approval. Dec - Jan LHIN review of the 2013/14 CAPS & LHIN/HSP consultations on 2013/14 M-SAA indicators. Negotiations with HSP’s from their submissions. Send back indicators with letter of amendment to M-SAA various schedules Jan 31 HSP Board approval of M-SAA refresh. Sign back by HSP on Board Approval date –due to the MH LHIN by the final date January 31 2013 April 1 Year 3 of the current 2011-14 M-SAA comes into effect HSPs will have approximately six (6) weeks to complete the 2013/14 CAPS refresh forms in Excel and return them to the LHIN for review. The CAPS refresh forms will be emailed to the HSP contacts according to the tentative timelines listed There will be a technical User Guide provided with the release of the CAPS refresh forms. The technical User Guide will provide relevant instructions on the mechanics of completing the forms. The HSP Board-approved CAPS refresh must be submitted to the LHINs no later than November 30, 2012.

CAPS Guidelines Principles Guiding the 2013/14 CAPS & M-SAA Refresh Demonstrate Accountability between the HSP and the LHIN The CAPS refresh will inform the ongoing M-SAA between the LHIN and the HSP; The HSP will be accountable to the LHIN for the achievement of the performance obligations in the M-SAA. Funding and Allocation HSPs are expected to plan to achieve a balanced operating position for the program and total organization for each year of the M-SAA. Integration and Service Coordination HSP planning must reflect the HSP’s ongoing responsibility to operate in an efficient manner in both administrative and direct service areas which may include consultation with other HSPs. Local Health System Planning HSP planning must be in alignment with the LHIN/Ministry priorities, reflect best practices and based on evidence-informed decisions. To give this slide context lets begin with a brief review of The local Health System Integration Act 2006. The act provides the foundation for the accountability relationship between the LHINs and the community health service sector. The purpose of the act is to provide for an integrated health system that will improve the health of Ontarians through –better access to high quality health services, coordinated health care in local health system and across the province and effective and efficient management of the health system at the local level. The accountability agreement with the MOHLTC sets out Performance goals and objectives Performance standards, targets and measures Requirements for the LHIN to report on its performance and the local health system Requirement that the LHIN provide a plan for spending the funding that the LHIN receives from t he MOHLTC and A progressive performance management process The LHSIA permits the LHIN to provide funding to an HSP for services that the in the geographical area of the LHIN In keeping with the expectations of the described requirements the following categories are the principles guiding the 2013-14 CAPS and M-SAA refresh process—( Refer to the slide above)

CAPS Guidelines Planning for the 2013/14 CAPS & M-SAA Refresh The 2013-14 refresh will require the HSP to prepare (and consult with the LHIN on): description of services; a financial budget; a service activity budget; performance indicator targets and corridors; and LHIN specific performance requirements (where applicable). The MOHLTC has not announced an annual incremental funding allocation adjustment for 2012/13 or 2013/14. As such, HSPs are required to plan and submit a budget based on a 0% funding adjustment. An HSP must consider this planning assumption when developing its forecasts on service volume and indicator performance. HSPs are required to plan and submit a budget based on a 0% funding adjustment. HSPs should use their known 2012-13 base funding allocation plus any committed 2013-14 one-time funding allocation for the preparation of the 2013-14 budget, unless otherwise specifically instructed by our LHIN.

CAPS Components Identification All users must complete the instructions for Excel provided in the User Guide in order to begin working in the file. In Step 1 HSPs are required to complete the Identification screen. LHINs will use this information during review to send inquiries about the submission. When you receive your file from the LHIN, it will be an excel document. Once again, this file will be emailed to you on October 15, by the LHIN The file is something that you are familiar with. It may look different at the start, but the information required is the same. With this CAPS version, there is no CAPS Transition File, nor are you required to have other files in a folder like we did in the past. NOTE – All the components of CAPS are contained in this one excel file. Instructions: Please….read the User guide prior to completion of this file. ALSO, we are all using different excel versions, first thing to remember is to refer back to the User Guide and Look at Appendix A – the set up instructions for excel is important before you begin working in the file. This will help with some of the macros. There are a total of 6 steps to follow to complete the CAPS. Step #1- is the identification page Please fill out each information cell on this page All yellow- highlighted cells are mandatory fields, indicated with red text. An edit check at the end will occur if the yellow high-lighted field is not filled. Once completed, select return to Main page.

CAPS Components Service Plan – 2013/14 Financial & Service Activity To update the 2013/14 financial and service activity, HSPs are required to complete Steps 2, 3 and 4 in the CAPS excel based reporting tool. The HSP should prepare the financial budget and service activity budget based on the historical activity for the organization, adjusted for planned changes in service activity and/or changes recently implemented. HSPs are required to plan and submit a budget based on a 0% funding adjustment. HSPs should use their known 2012-13 base funding allocation plus any committed 2013-14 one-time funding allocation for the preparation of the 2013-14 budget, unless otherwise specifically instructed by your LHIN. Step 2 – financial & FTE Program Plans Each health service provider should only complete plans for each Transfer Payment Business Entity (TPBE) for which they are funded. Some of you will have one or some of you may have more than one. Similar to what we did in last CAPS submission….no change. Please note, that screen shots are only for LHIN managed reports. The ministry managed reports are similar and will not be shown in this presentation.

CAPS Components Service Plan – 2013/14 Financial & Service Activity STEP 2 – Financial & FTE Program Plans Change to this form compared to prior CAPS--Both the Financial and FTE program plans have been combined into one form. Step #2 The FTE planning section can be found after the REVENUE & EXPENSE Section- we will discuss further in later sides Looking at the form in a glance. The red triangles that appear in the right upper corner in the description column – 1st column shows the line corresponding MIS CODE. This will allow for mapping to your MIS reports. Column C – this value represents this years adjusted budget. This should tie back to what you are showing on your Q2 CATSRI report. Unfortunately, this will have to be populated by your organization. Column D – 2012/13 FORECAST – this value represents this year’s forecasted actual that you will be as reported by your Q2 CATSRI report. The Column E is your planning number. NOTE- HSP are required to plan and submit a budget based on a 0% funding adjustment. HSPS should use their known 2012 – 13 base funding allocation for the preparation of the 2013/14 budget. With a zero base funding adjustment your 2013/14 funding can be found by using your October payment notice base allocation column. If you received one-time this year, those dollars will not be part of your plan funding for 2013-14. For those agencies who have just received a funding letter with base dollars and it is not reflected in their payment notice, you should include that amount in your budget plan. Not many of you. Comments column is used for any additional comments regarding significant changes that you need to explain to the LHIN and perhaps a reminder to yourself. Last column the Change in % - looks at the variance between Budget 2012/13 to Budget Target 2013/14 . Paymaster Arrangements For those who have Paymaster arrangements – same as before, enter the amounts on excel line 64. Make sure you provide the details of each arrangement like before. The amounts will get populated in the financial section in the Revenue section, just like before. FTE’s –(can be found after the revenue and expense section) Review the OHRS definitions of FTEs for any clarification you require. Broken down by the same category ----Administration & Direct Services The amounts entered will be automatically transferred to the Financial Planning section. Overview as per Guideline: Balanced budget is required for each TPBE and for the total entity. Note that the LHIN funds each HSP for specific Transfer Payment Business Entity. As per the community Financial Policy 2011- funding cannot be allocated across TBPEs.

CAPS Components Service Plan – 2013/14 Financial & Service Activity STEP 3 – Service Selection Page STEP #3 The Service Selection Page is similar to before Agencies are to select services and functions that are unique to their organization Enter an “X” in the right column to select services that the agency delivers. This is important because when we go to the activity page and other forms for the CAPS, only services that are marked here will show up. The Administration line has been pre-selected for you. Hit “return to the Main Page” once completed.

CAPS Components Service Plan – 2013/14 Financial & Service Activity STEP 4 – Activity Planning Page STEP #4 If a provider has chosen all the correct services from the previous slide, then only services that have been chosen will be displayed in the Activity Planning section in CAPS. To add services, you must go back to the previous step Some information that you have seen before in the past with your CAPS and CATLit reporting. Column headings similar to that of the financial plan and FTE that we had discussed. Once again, budget 2012/13 and forecast 2012-13 will have to populated manually. This should tie back to your Q2 CAT SRI reporting. Each of the total yellow lines under each service are mandatory and must be completed for the 2013 – 14 budget target. OVERVIEW / REMINDER Total Cost of all your Functional Centres must tie back to your Total Fund type 2 Expense (edit check on this one)

CAPS Components Service Plan – 2013/14 Financial & Service Activity The data provided in steps 2,3 and 4 as outlined above will automatically generate Schedule B1 (Summary of Revenue & Expenses) & Schedule B2 (Activity Summary) *Shown for information only under Step 5.* Thus in filling out the Forms that we have just reviewed will generate Schedule B1 – summary of Revenue and Expenses and sechedule B2 – Activity schedule for the MSAA. This is for information only.

CAPS Components Detailed Description of Services To update the detailed description of services for 2013/14, HSPs are required to complete Step 5 in the CAPS excel based reporting tool. Step 5 – other components of the CAPS are the following - the “Detailed Description of Services” and the “Population & Geography Narrative”

CAPS Components Detailed Description of Services STEP 5 – Detailed Description of Services Update Schedule A1- Detailed Description of Services if you have added MIS Functional Centers. If there are no changes, please click “No Changes”. Please refer to your 2011-12 Q4 report and your original 2011-14 CAPS for a summary of all of the Functional Centres that you previously reported. Note: if the current Functional Centres are not the most appropriate to report based on your renewed understanding of the services delivered, please use this opportunity to discuss changes with your LHIN prior to changing and subsequently update the Functional Centres accordingly. This screen will only display those services that were selected in Step #3 Similar to the last MSAA agreement This becomes part of your A1 schedule of the MSAA If there has been no change since your last MSAA, then click the “no change” and a check mark will appear.

CAPS Components Population & Geography Narratives STEP 5 – Population & Geography Narratives Update Schedule A2- Population and Geography Narratives if you have had changes in geography and population served. If there are no changes, please write “no change”. This form is also quite similar to the prior CAPS submission. Once again, refer back to your current MSAA agreement and verify if client populations and geography area served has changed over the past two years. If there has been no change, HSPs should write “NO CHANGE” Limitation – is the amount of space that is provided.

CAPS Components Verify Edit Checks After completing Steps 1-5, HSPs will verify the entry and check for errors or omissions in Step 6. Happy faces indicate successful edit checks. Sad faces indicate failed edit checks, which must be corrected. After completing Steps 1-5, HSPs will verify the entry and check for errors or omissions in Step 6. Happy faces indicate successful edit checks. Sad faces indicate failed edit checks, which must be corrected. Some of the edit checks are as follows : HSP identification screen – mandatory fields are completed. All FTEs planned are allocated to a Functional Centre on the LHIN Activity Screen Total Fund Type 3 is not planned as a Deficit. Total Revenue and Total Expenses for Fund Type 2 must be balance to zero on the financial planning form for each TPBE. And so on. Since you are emailing this to the LHIN, you are still able to send this file with errors. However, LHINs will make sure there are no errors before they will work with the file. If errors, the file will go back to the provider. Overview: All Providers should have the following files: CAPS 2013 -/14 User Guide CAPS 2013-14 LHIN.xls (file for LHIN –managed programs – will be given to you October 15th) CAPS 2013- 14 minstry.xls (file for ministry managed programs – will be given to you October 15th) CAPS 2013-14 Guideline CATSRI Q2 2012-13.xls – access to this file. All the above will help organizations to meet the deadline date - NOVEMBER 30th The files will be emailed back to the LHIN and must be approved by your Board.

Performance Indicators 2013/14 M-SAA Indicators COMMUNITY SECTOR ADVANCING HEALTH SYSTEM PRIORITIES: To assist the HSP to achieve ongoing performance improvement, the Health System Indicator Initiative (HSII) has refreshed the listing of indicators to ensure alignment with the Ministers Action Plan and the four pan-LHIN system imperatives (see slides 20 & 21). RIGOROUS INDICATOR SELECTION PROCESS: HSII consists of nearly 30 members including representation from 10 LHINs, MOHLTC Health Analytics Branch and Health Quality Branch, LHIN Liaison Branch, Health Quality Ontario, the Canadian Institute for Health Information, Cancer Care Ontario, the Institute for Clinical Evaluative Sciences and Health System Performance Research Network. Strong sector engagement and consultation throughout the indicator refresh process has been a critical success factor for establishing relevant performance measures. INDICATORS ENDORSED BY SECTOR ASSOCIATIONS AND M-SAA STEERING COMMITTEE: The final listing of indicators is expected to be endorsed over the next few weeks by the M-SAA Steering Committee** (comprised of representatives from OACCAC, OANHSS, CMHA, AOHC, MOHLTC, OFCMHAP, sector representatives) and approved by the LHINs. The listing of indicators for the 2013/14 M-SAA is expected to be finalized over the next few weeks by the M-SAA Steering Committee and LHIN CEOs. A draft listing is currently listed on pages 14 and 15 within the CAPS and M-SAA 2013/14 Refresh Guidelines. The final listing of indicators, refresh Schedule E templates, technical specifications, target/corridor setting guidelines will be provided on November 30th 2012. The Technical Specifications document will be posted on or MH LHIN website.

Ministers Action Plan Keeps people healthy Focused on prevention, promotion, and self-management Developed strategies for priority populations Faster access to family health care Have built a strong primary care foundation, with broad access to specialty and community services Right care, right time, right place Focused on patient-centric delivery Implemented standardized system-wide approach to quality management and improvement Have governance models that engage clinicians and the public in decision-making, enabling informed service provision that meets community needs in a timely way Developed a system structure to integrate services along the continuum of care, optimize coordination, and foster effective partnerships Utilized shared electronic medical records

LHIN’s Provincial Priorities Pan-LHIN imperatives Enhancing Access to Primary Care – focused on advancing strategies to ensure people have timely access to a primary care provider and creating enabling structures and processes to align primary care more effectively within the overall continuum Enhancing Coordination & Transitions of Care for Targeted Populations – e.g Seniors Strategy: focus on seniors have individualized plans of care that allow them to receive the care they need, when and where they need it; and the transitions post-acute are smooth and coordinated Implementing Evidence Based Practice to Drive Safety - focused on high priority safety issues that require consistent, coordinated responses to ensure that patents are safe and that adverse events are minimized/eliminated Holding the Gains – focused on ensuring that new initiatives will not cause previous gains to be eroded (e.g., ER/ALC, ER Wait Times, and access to care, coordination amongst providers, enhanced focus on accountability)

Performance Indicators 2013/14 M-SAA Indicators The final listing of indicators, technical specifications, target/corridor setting guidelines and Schedule E - Performance templates, will be provided on November 30th 2012. The technical specifications document will be posted on all LHIN websites. A draft listing of core and sector specific indicators is available in the Guidelines. Following the submission of the November 30th CAPS, LHINs and HSPs will consult on the accountability indicator targets appropriate to the organization and local circumstance. The LHIN will also provide historic data, where necessary, on certain indicators and this will be the starting point for the discussion of targets for the 2013/14 M-SAA Schedule E. Performance Indicators: Core Indicators- applicable to all Health Service Provider Organizations a required indicator relevant to all LHINs and all community sectors Sector Specific Indicators: which are applicable to health service providers within that sector, a required indicator relevant to a specific sector MH LHIN Specific Indicators : an indicator determined locally to be relevant

M-SAA Refresh Content - Schedules Title Description A Description of Services Describes the services delivered by the HSP, client populations and geography served B Service Plan Describes the financial and statistical status of the HSP C Reports Identifies, describes and sets due dates for HSP reporting D Directives, Guidelines, Policies Identifies applicable MOHLTC policies E Performance Identifies indicators, standards and local performance requirements F Template for Project Funding Permits funding for special projects G Declaration of Compliance Form to be completed by the HSPs Board of Directors to declare that the HSP has complied with the terms of the Agreement (Due to the LHIN at Q2 and Year End) HSP Providers-The schedules in black have remained the same in the Refresh. Schedules highlighted in red will be amended to the current 2011-14 M-SAA

HSP Responsibilities Each HSP Board must approve the 2013/14 CAPS prior to submission as this serves as the basis for the preparation of the 2013/14 M-SAA Schedule refresh. HSP’s are expected to work within the timelines posted for a successful submission. Failure to meet the timelines outlined is a contravention of your M-SAA and the LHIN will take necessary performance improvement steps to rectify the non-compliance, as available in the M-SAA, up to and including termination. Board approval will be required under Each HSP Board for the 2013/14 CAPS prior to submission as this serves as the basis for the preparation of the 2013/14 M-SAA Schedule refresh. Contact either Mirella Semple or Carrie Parkinson or your MOH stats officer in a timely manner if you have any questions or interpretation issues about the functional centres or statistical reporting.

Next Steps Website Webinar presentation posted on the Mississauga Halton LHIN website 2013/14 CAPS forms to be posted as soon as they are available (on or before October 15th 2012) LHINs will review 2013/14 CAPS submissions, follow-up with HSPs on any questions and clarifications needed. 2013/14 M-SAA Amendment letter to be available November 30th 2012. Final Indicator Listing, Technical Specifications and Performance Schedules to be available November 30th 2012. LHIN Communication Agencies should expect frequent emails from the LHIN regarding FAQs and provincial communiques

LHIN Contact Information For any questions concerning the CAPs & MSAA Refresh submission please contact one of the following individuals: Mirella Semple, Senior Lead Funding and Allocation – mirella.semple@lhins.on.ca or at 905-337-4894 Carrie Parkinson, Senior Lead Performance – carrie.parkinson@lhins.on.ca or at 905-337-7131ext.243

QUESTIONS?