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

2. Agenda MSAA Governance Structure Context CAPS
Changes to the CAPS
CAPS Narrative Completion
CAPS Narrative Submission
Additional Resources
CAPS Demo
MSAA Schedules Overview
MSAA Indicators Overview
CAPS & MSAA Schedules Timelines

3. 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

4. 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

5. CAPS

6. CAPS Changes for
Removed 4 Functional Centres that changed to Account Headers effective April 1, 2018
COM Clinics/Programs - Therapy Clinic Removed
COM Clinics/Programs – Chronic Disease Clinic
COM Health Prom/Educ. & Com Dev- Personal Health and Wellness
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
Clinics/Programs - Chronic Disease – Cardiac Rehabilitation Clinic
Personal Health and Wellness – General
Existing in OHRS (New to CAPS reporting)
Personal Health and Wellness – Mental Wellness, Personal Health Practices and Coping Skills
Personal Health and Wellness – Oral Health
Personal Health and Wellness – Healthy Child
Personal Health and Wellness – Youth Development

7. 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 and
These columns are not locked but do populated from the input into the Budget column E
Variance calculations have been added for each line to highlight changes between the CAPS budget (original) and the 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 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

8. 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
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

9. 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 , 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 system

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

11. Additional Resources & Education for the CAPS Refresh
The new CAPS narrative has a recorded training webinar: HSP Completion:
The CAPS has a recorded webinar that mirrors the written completion guide:

12. CAPS Demo Detailed step by step training is available in the CAPS completion guide and through the recorded webinar at:

13. Schedules

14. 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.

15. 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

16. 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
Updated to reflect
B2: Clinical Activity Summary
The information is redundant as it is a summary of other information collected
C - CHC
Added applicable reporting dates for
Updated to reflect applicable reporting periods
Community Engagement and Integration Activities Reporting added
Was added to the MSAA template in
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 See footnote note in schedule.

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

18. 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

19. Indicators

20. 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

21. 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

22. 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.                  

23. 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

24. 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.

25. 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.

26. 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

27. 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)

28. 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’)

29. 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)

30. 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

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

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

33. 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

34. 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

35. 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.

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

37. 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

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

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

40. 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 , 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 , 2019
HSP-signed MSAAs returned to the LHIN by
March 15, 2019
MSAA comes into effect
April 1, 2019

41. Appendix 1: LHIN Contact Information
LHIN
Name
Secondary Contact and
ESC
Jean-Francois Gauthier SW
Amina Sogolj WW
Blair Philippi /
HNHB
Ashley Bolduc CW
Neil McIntosh MH
Jeanny Lau TC
Nello Del Rizzo C
Edin Wong CE
Michelle Nurse SE
Joe Sherman CH
Colleen Taylor
NSM
Jenna Mitchell NE
Barry Lajeunesse NW
Kevin Holder
Eforms
Kelvin Luk

42. 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)

43. 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

44. 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