1. Performance Contract and Allocation Overview

2. What LHINs Do IHSP: Setting the Course Patient Centred
30/11/2018
What LHINs Do
IHSP:
Setting the Course
Community Engagement
Accountability
& Performance
Monitoring
Accountability Agreements:
Executing the Course
Patient Centred
Integration & Service
Coordination
Local Health
System
Planning
Funding & Allocation

3. What does this look like?
30/11/2018
What does this look like?
What has changed as of April 01, 2007?
Accountability
Tool kit
Performance
Monitoring
Accountability Agreements:
Executing the Course
Accountability & Allocation

4. 30/11/2018
Video clip
Video Clip

5. What changed as of April 1?
30/11/2018
What changed as of April 1?
World on April 2 was much the same as it was on March 31, 2007
Transformation will be evolutionary not revolutionary
Health Service providers will want to prepare for:
An increased emphasis on accountability
A focus on integration & improved service coordination
new approaches to everything from funding to health system planning
(ASK THE AUDIENCE): What is the one thing that will predict success in the 21st Century?
Take points…
The one thing that will fundamentally predict either an organization’s or individual’s chances for success in the 21st Century is the “Capacity and Capability to handle Change”
Review favourite books (ASK THE AUDIENCE for a show of hands): who has read:
Leadership by Rudolph Juliani ?
29 Leadership Secrets from Jack Welsh ?
The 7 habits of Highly effective people by Stephen Covey?
The 7 Principles for Making Marriage Work: John Gottman? Given all of the travelling I do since arriving at the LHIN, this one is required reading for any LHIN employee…(smile)

6. 5 main areas where changes will be felt…
30/11/2018
5 main areas where changes will be felt…
Increased integration and improved service coordination
Increased local decision-making about funding and allocation
Greater emphasis on local health system planning
Increased community engagement
Enhanced Accountability

7. 1. Increased integration & improved service coordination
30/11/2018
1. Increased integration & improved service coordination
After April 01, health service providers will:
Be responsible for aligning their service planning within the CE LHIN IHSP
Implement the directions for integration laid out in the accountability agreements with CE LHIN
Demonstrate continuous improvement in service integration & coordination (LHIN will help facilitate shared best practices through our Comm Engagement structures)
Take part in agreements and initiatives designed to further provincial objectives in areas such as access, quality, safety and efficiency

8. 2. Increased local decision-making about funding & allocation
30/11/2018
2. Increased local decision-making about funding & allocation
CE LHIN will…
Assess priorities at local level
Determine service configuration based on priorities
Allocate funds accordingly
Monitor fiscal performance & contribution of providers to ensure integration & system sustainability
Health Service Providers will…
Submit business and service plans as required by their accountability agreements (same tools for now)
Be responsible to CE LHIN for delivering programs and services on budget

9. Was it vetted by your Planning Partners? Is it aligned with the IHSP?
30/11/2018
Integration Initiatives/Ideas/Proposals
Was it vetted by your Planning Partners?
Is it aligned with the IHSP?
Is it evidence-based and can it be measured & monitored? (ie., Decision Support & Performance Monitoring)
Who shares accountability for its accomplishment? (ie., agreements & funding)
How will it be resourced?
2. Is it aligned with the IHSP – add comments that if it is not. Then why is it important.

10. 3. Greater emphasis on local health system planning
30/11/2018
3. Greater emphasis on local health system planning
CE LHIN will…
Identify and determine local health care priorities
IHSP to reflect local priorities & link with provincial strategic directions
Health Service Providers will…
Continue to participate in CE LHIN Planning exercises
Align strategic plans with those of CE LHIN
Provide input and info necessary for CE LHIN Plans

11. 5. Greater Accountability
30/11/2018
5. Greater Accountability
People have the right to expect accountability from their governments
To that end, CE LHIN has entered into an accountability agreement with MoHLTC
Patients have the right to expect that their health service providers will be accountable for the quality of services they provide
To that end, part of CE LHIN mandate is to negotiate Service Accountability Agreements (SAAs) with health service providers

12. Accountability Framework
30/11/2018
Accountability Framework
STEWARD MANAGER PROVIDER
MOHLTC
LHIN 1
LHIN 2
LHIN 14
Hospitals
CCAC
LTC Homes
CSS
MH&A
CHC
OTHER
Strategies and Directions
- Tools and processes are
being developed
Operationalizing Policy/Direction
Tools/processes NEED
to be developed
∙ ∙ ∙

13. Ministry of Health & Long-Term Care & the Central East LHIN
Accountability Agreement

14. Primary Agreement Purpose
30/11/2018
Primary Agreement
Purpose
Supports the collaborative relationship between the MOHLTC and LHIN to carry out the made in Ontario solution to improve the health of Ontarians
To set out the mutual understandings between the MOHLTC and the LHIN of their respective performance obligations in the period from April 1, 2007 to March 31, 2010
The Primary Agreement was previously reviewed and approved in principal in November 2006

15. Agreement Components Primary Agreement Schedule 1 General
30/11/2018
Agreement Components
Primary Agreement
Schedule 1 General
Schedule 2 Community Engagement, Planning and Integration
Schedule 3 Local Health System Management
Schedule 4 Information Management Supports
Schedule 5 Financial Management
Schedule 6 Financial Processing Protocols
Schedule 7 Local Health System Compliance Protocols
Schedule 8 Integrated Reporting
Schedule 9 Allocations
Schedule 10 Local Health System Performance

16. Building Blocks for YEAR 1
Where are we at?
Building Blocks for YEAR 1

17. Our mantra: “Heard, Found, Do”
30/11/2018
Times have changed: Environmental Scanning is secondary to community engagement, it quantifies what we heard.
What We Heard
(Engagement)
What we Found
(Environment Scan)
What We Will Do
(Our Plan)
Number of seniors in CE LHIN and its Planning Zones
Population Growth of Seniors
Estimate of dementia cases in seniors
1.1 Improve access to LTC home services
Priority 1:
Seamless care for Seniors
Seniors
1.2 Enhance coordination of services
Seniors
1.3 Reviewing and building specialized geriatric services
Our mantra: “Heard, Found, Do”

18. We Own This Now! WISDOM KNOWLEDGE INFORMATION DATA
30/11/2018
We Own This Now!
WISDOM
How to make programs work together to improve health outcomes for a given population
KNOWLEDGE
How agency provides service, other similar services, total units of service in an area related to population.
Very limited use of data to inform operations and planning.
INFORMATION
Profile of agency, type of service, location, number of clients
DATA
Raw counts of units of service, or total expenditures. Databases.

19. Central East LHIN Planning Zones
Haliburton Highlands
Kawartha Lakes
Peterborough City & County
30/11/2018
Environmental Scan Overview—Our Population:
The CE LHIN geography stretches from the culturally diverse and densely populated Scarborough planning zones to the rural and less populated areas of Haliburton Highlands, and northern sections of the City of Kawartha Lakes and Peterborough Counties.
The population is mainly concentrated in the South West area of the LHIN, with almost 50% of the population in Scarborough.
The area is characterized by rapid population growth for certain age groups and the second highest percent of those over 65 in the province. The 85+ age group will increase by over 91% between 2001 and 2016, and the age group will decrease by 0.5% for the same period.

20. Example: Historical Wait-time Trending Diagnostic Imaging - CT Scan
30/11/2018
Example: Historical Wait-time Trending Diagnostic Imaging - CT Scan

21. How we Approach Performance
30/11/2018
How we Approach Performance
March 2008 Estimated WT for MRI = 115
It takes people to bend this curve

22. Health System Scorecard
Example of Health System Goal Managed by LHINs
30/11/2018
10.10%
Strategy Map
9.20%
8.79%
9.62%
9.75%
9.10%
Improve patient-centredness, integration and quality of health services
Health System Scorecard
Performance measure Score
Total number of days percentage alternative level of care (ALC) %
MLAA -negotiation
MLAA -negotiation
MLAA -negotiation
Average across Ontario
LHIN (1) Scorecard
LHIN (2) Scorecard
LHIN (3) Scorecard
11.04%
Performance measure
Total number of days ALC
Target
Score 7.72%
7.72%
Performance measure
Total number of days ALC
Target
Score
10.30% 8%
Performance measure
Total number of days ALC
Target
Score 11.04% 9%
10.30%
5.27%
LHIN 1
LHIN 2
LHIN 3
Average across LHIN (2)
LHIN (2) negotiates service agreements with its hospitals on an individual basis regarding strategies for managing alternative level of care patients: e.g. conducting a daily utilization review to determine appropriateness of admission and readiness of discharge; developing closer relationships with community agencies, etc.
12.09%
10.55%
Hospital (A) Report
Hospital (B) Report
Hospital (C) Report
3.85%
Performance measure
Total number of days ALC
Score 10.55%
Performance measure
Total number of days ALC
Score 3.85%
Performance measure
Total number of days ALC
Score 12.09%
Hosp A
Hosp B
Hosp C

23. The “Toolkit”: Accountability Agreements
30/11/2018
The “Toolkit”: Accountability Agreements
HSP Service Agreements
HAPS/HAA
Funding Proposals
Capital/PCOP
Risk Management
What we’ve already done -
HSP Service Agreements - Completed
Compiled a core set of indicators from which LHINs can select measures to monitor and/or report on LHIN system and accountability and progress towards meeting the LHIN’s IHSP goals.
As John mentioned, your agreements with us must align with our agreements with the Ministry and our MLAA.
HAPS/HAA - Completed
Defined the overall HAPS/HAA framework, process, tools and timelines required to successfully negotiate service accountability agreements to enhance hospital stability and accountability.
We will monitor in-year progress towards targets.
Process design includes engagement startegies to involve the HSPs to ensure an integrated approach is being used in developing and implementing Health Provider plans.
Where we are now -
Funding Proposals – Expected by mid June
Developing a consistent approach for all LHINs to respond to unsolicited funding requests and proposals from Health Service Providers
In th enew LHIN environment, enhanced accopuntability for operating in a financially responsible manner is assigned to the HSP.
Develop a standard template to link HSP funding requests to local strategic priorities and initiatives.
Capital/PCOP – In Progress for Process Model and Chart
Defining the overall framework, processes, tools and timelines that LHINs will use in the receipt, review and approval of capital projects,
Also define the role of the LHINs in this process in its interaction with MOHLTC, Ministry of Public Infrastructure and HSPs.
Developing the Risk Management Framework and Communications Plans

24. The “Toolkit”: Population-based Funding
30/11/2018
The “Toolkit”: Population-based Funding
Funding Letters
- Summer 2007
In-Year Pressures
- Late Summer 2007
Transfer Payment & Allocation Management
Where we are going -
Funding Letters - Mid to end of June
Define the business processes associated with allocation letters to be issued by LHINs. The immediate focus is to define the business process associated with the allocation/assignment letters for the fiscal year.
In-Year Pressures – Late Summer 2007
To develop a framework for LHINs to receive and review integration initiatives for handling of in-year pressures from health service provider organizations.
The framework will contain criteria to prioritize the relative urgency of in-year pressures and any requirements for mitigation strategies.
Ask the 5 questions mentioned earlier.
Transfer Payment & Allocation Management - in progress
Comprehensive business processes associated with annual appropriations thru RbP (Results-based Planning)
Quarterly reports are a key element to the Reporting and Business Planning Framework to support accountability, risk management and decision support.
We are in process of defining TP allocation framework, reporting processes, tools and timelines to fairly allocate funds to the HSP’s to address needs of the population in the catchment area.

25. 30/11/2018
A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.
- Sir Winston Churchill

26. 30/11/2018
Discussion
And
Questions