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

2. Agenda Multi-Sector Service Accountability Agreements (MSAA) 3
MSAA Governance Structure
Toronto Central LHIN’s Performance Management Framework
Planning for ’s MSAA
Changes to the CAPS
Additional Resources & Education for the CAPS Refresh
Important* Considerations when Completing CAPS Refresh 16
CAPS & MSAA Schedules Timelines
Appendices:
MSAA Schedules Overview
MSAA Indicators Overview
Contact Information and MSAA Advisory Committee membership
Neil

3. 1. The Multi-Sector Service Accountability Agreement
Neil

4. 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)

5. 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)

6. 2. MSAA Governance Structure

7. 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

8. 3. Toronto Central LHIN Performance Management Framework
Neil

9. 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

10. 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 % 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 % 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

11. 4. Planning for ’s MSAA
Neil

12. Planning for ’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

13. 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
Confirmed that Community Paramedicine ( ) has been added to the CAPS and quarterly templates
Mike

14. 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 populate 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
Mike

15. Additional Resources & Education for the CAPS Refresh
HSPs should first utilize the below resources when completing the CAPS, and if they still require support, please reach out to or your Performance Lead (slide 48.)
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:
All resources related to CAPS will be uploaded by EOD 19th Oct, to Toronto Central LHIN’s website at
All data standards inquiries for all sectors should be directed to For directions on how to direct inquiries, please access the PDF embedded here
Mike

16. 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-
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)
For questions or issues related to using FMT, contact
Community Health Centres: Supplemental Indicators
Starting , Toronto Central LHIN is requesting that all CHCs begin reporting on non-insured clients
Revision of Local Obligations for
Data errors
Mike

17. 5. CAPS & MSAA Timelines
Neil

18. CAPS & MSAA Timelines
HSPs received a communication on October 10th with key timelines for planning submissions
Timelines are also available on our website at:
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
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 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 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 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

19. Questions?
Laura

20. Appendix 1. 2019-20 MSAA Schedules Overview
Neil

21. 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:
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

22. 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 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

23. 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
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.
Neil

24. Recommended Changes to 2019-20 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
Neil

25. 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

26. Appendix 2. 2019-20 MSAA Indicators Overview
Laura

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

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

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

40. 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

41. 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 )
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

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

43. 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

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

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

46. 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.

47. 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

48. Performance Management Team
Appendix 3: Toronto Central LHIN Contact Information
Performance Management Team
Name
Role
Phone
Sheila Banks-Switzer
Director, Performance Management
ext 2596
Luciano Veta
Manager, Contracts and Performance, Hospital MSAAs
ext 3223
Andrea Tsuji
Senior Consultant, MH&A
ext 3378
Laurent Tyers
Senior Consultant, SPO
ext 2508
Nello Del Rizzo
Senior Consultant, CSS
ext 3224
Shama Umar
Senior Consultant, Primary Care
ext 3217

49. 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)

50. 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

51. 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