1. Hospital Accountability Planning Submission (HAPS) Process Fiscal 2016/17 Presented in Fall 2015

2. Agenda 1.Context 2.HSAA Organizational Structure 3.Guiding Principles 4.Differences between 2015-16 and 2016-17 HAPS Submission Timelines HAPS Guidelines Additional Updates 5.Projected Timelines for 2016-17 6.Planning for Key Variables 7.Planning Environment Considerations 8.Assumptions 9.Appendix A: HSAA Planning & Schedules WG Membership 10.Appendix B: SRI Reports WG Membership 11.Questions

3. Context Planning for 2016/2017 The HSAA Template Agreement is envisioned to be a multi-year agreement established through consultative stakeholder meetings between the LHINs, hospitals, the OHA and MOHLTC. The Schedules content will be negotiated annually. Information collected through the Hospital Accountability Planning Submission (HAPS) and the Additional Input forms will be used to populate the HSAA Schedules. Both the HAPS forms and the guidelines have been refreshed. The HAPS and related draft Schedules will cover one fiscal year (FY 2016/17). 3

4. Context Planning for 2016/2017 The government continues to implement Health System Funding Reform (HSFR), which supports system capacity planning and quality improvement through directly linking funding to patient outcomes. LHINs and the hospitals recognize that HSFR will impact the HSAA process. Hospital funding has become unique to each individual hospital with the roll out of the Health Based Allocation Model and Quality-Based Procedure Funding (QBP) and so “across the board” planning targets are no longer relevant or possible. 4

5. Context Planning for 2016/2017 Hospitals are currently engaged in developing budgets to guide operations for fiscal 2016/17 as part of their organization’s fiduciary duty, and hospital services will continue to be provided to patients according to the hospital’s internal plan and based on the hospital’s best assumptions. There is great benefit for hospitals and LHINs to agree on performance expectations within a set of parameters that begins on day one of the fiscal year. The vehicle for this agreement is the HSAA. 5

6. HSAA Organizational Structure Creating an ownership framework Hospitals (OHA) HSAA Steering Committee HSAA Planning & Schedules Work Group SRI Reports Work Group HSAA Indicator Work Group LHINs 6

7. HSAA Organizational Structure Creating an ownership framework The HSAA Planning & Schedules Work Group is co-led by Sherry Kennedy, Chief Operating Officer of the South East LHIN, and May Chang, Executive Vice President, Strategy & Patient Experience, Markham Stouffville Hospital. The SRI Reports Work Group is led by Pete Crvenkovski, Director of Performance Quality & Knowledge Management at Erie St. Clair LHIN. Based on the HSAA Steering Committee’s planning assumptions, the core deliverables of the HSAA Planning & Schedules Work Group were to prepare draft schedules and planning submission documents and produce related education materials. 7

8. Guiding Principles Developing the HAPS materials The deliverables of the Planning & Schedules Work Group were set with the following guiding principles in mind: 1.Practicality - Develop products that reflect our current reality and are easy to use/understand. 2.Emphasis on local within the provincial context - For planning targets, performance indicator targets and other health system changes. 8

9. Guiding Principles Developing the HAPS materials 3. Partnership Approach - Hospitals and LHINs should liaise early and often in order to develop a mutually acceptable HSAA within the requisite timeline. 4.Ensure alignment. All core HAPS/HSAA materials (Guidelines, Forms and Schedules), should align with one another. The Work Group will also strive for enhanced functionality whereby one form/schedule may be pre-populated by another where appropriate. 9

10. Differences between 2015-16 and 2016-17 HAPS Submission Timelines Over the past few years the HAPS document has had a due date in January. This often resulted in an abbreviated review of the submissions by the LHIN resulting in multiple production runs of the schedules due to changes. The additional time afforded to the Hospitals did not make a significant difference in the value of the HAPS plan in the overall HSAA agreement. Most Hospitals begin their planning process in September to allow time to implement changes in cost structures. 10

11. A standardized Work plan has been endorsed by the LHIN CEOs and will be implemented in 2016-17 to provide predictable dates for key deliverables for all future years. For 2016-17, the HAPS submission is due on Monday November 23 rd, 2015. The LHINs do not consider the submission on the 23 rd to be final as changes usually occur post submission up to January through the LHIN review process. The final HAPS is approved by Hospital Boards in January 2016. 11 Differences between 2015-16 and 2016-17 HAPS Submission Timelines

12. Updates to the HAPS Guidelines include: New content regarding Provincial Interest Programs Sexual Assault Clinics Embedded a hospital listing in the Narrative to guide hospitals through the completion of Section 2a and 2b Standardized the submission process through SRI for the HAPS Narrative and the Additional Input file Embedded within these documents are instructions on how to enable SRI submission. 12 Differences between 2015-16 and 2016-17 HAPS Guidelines

13. The Additional Input Form has been reduced in length HAPS narrative updated Includes a new Narrative for Hospitals with Sexual Assault Clinics There is a new Supplemental reporting Tab in the HAPS for LHIN use (hospitals should ignore this when submitting) Differences between 2015-16 and 2016-17 Additional Updates

14. ActivityTime Frame HAPS Completion HAPS on SRI HAPS Narrative (submit as document through SRI) HAPS Additional Input (submit as document through SRI) Oct 1/15 to Nov 23/15 HSAA Launch (Local) Local Education Draft Local Indicators & Performance Targets to Hospitals Nov 10/15 to Nov 16/15 Local Indicators & Performance Targets Negotiated & FinalizedNov 23/15 to Dec 18/15 LHIN prepares the Hospital Agreements and Schedules & sends for Hospitals for Feb 1/16 Jan 15/16 to Feb 1/16 Provincial UpdateDec 1/15 to Dec 4/15 Hospital Boards approve HAPSJan 1/16 to Jan 31/16 Hospital Boards approve HSAA agreement and returned signed copies to LHIN Feb 1/16 to Mar 31/16 Projected Timelines for 2016-17 HAPS and HSAA

15. Planning for Key Variables HAPS Key variables to consider when completing the HAPS include: Mitigation HBAM QBPs

16. Breaking the cycle of Rework The Mystery of Funding Scenario Planning It’s just a “Plan” Timelines Planning Environment Considerations HAPS

17. Hospitals will individually and locally determine reasonable planning assumptions for use in the completion of the 2016-17 HAPS. Use information currently available including assumptions for HBAM and Quality Based Procedures. The LHIN will review assumptions for reasonableness. In some LHINs, the LHIN and hospitals may collectively agree on a common set of assumptions. Assumptions HAPS

18. SectorOrganizationIndividual, Title LHINSE LHINSherry Kennedy, COO (Co-Chair) HospitalMarkham Stouffville HospitalMay Chang, Executive VP, Strategy & Patient Experience (Co-Chair) HospitalCollingwood General & Marine HospitalMichael Lacroix, Vice President, Corporate Services & CFO HospitalNorth York General HospitalDeepak Sharma, Director, Decision Support HospitalRed Lake Margaret Cochenour Memorial Hospital Paul Chatelain, Former President and CEO HospitalSt Michael’s HospitalTomi Nieminen, Director HospitalTrillium Health PartnersCarol Vinette-Hancharyk, Director, Financial Strategy & Deputy Chief Financial Officer MOHLTCMinistry of Health and Long-Term CareMaria van Dyk, Team Lead OHAOntario Hospital AssociationImtiaz Daniel, Director, Financial Analytics and System Performance Appendix A: HSAA Planning & Schedules Work Group Membership

19. SectorOrganizationIndividual, Title LHINCH LHINElizabeth Woodbury, Senior Accountability Specialist LHINMH LHINAndrew Wahab, Senior Lead of Funding and Allocation LHINNE LHINMarc Demers, Controller / Corporate Services Manager LHINNE LHINJoan Tonon, Data Analyst LHINNW LHINKevin Holder, Senior Consultant LHINSE LHINMike McClelland, Senior Financial Analyst LHINSW LHINScott Chambers, Team Lead LHINSW LHINBetty Wang, Financial Analyst LHINTC LHINChris Sulway, Senior Consultant LHINMH LHINLaura Salisbury, Executive Lead (Observer) Appendix A: HSAA Planning & Schedules Work Group Membership (cont’d)

20. Appendix B: SRI Reports Work Group Membership SectorOrganizationIndividual, Title LHINESC LHINPete Crvenkovski, Director, Performance Quality & Knowledge Management (Executive Lead) LHINESC LHINJean-Francois Gauthier, Performance & Finance Analyst LHINCW LHINChak Lee, Financial Analyst LHINMH LHINAndrew Wahab, Senior Lead, Funding and Allocation LHINNE LHINJoan Tonan, Data Analyst LHINNW LHINJames Anderson, Performance and Contract Management Consultant LHINTC LHINGreg Stevens, Senior Consultant, Performance Management LHINTC LHIN Mohamedraza Khaki, Consultant Performance Measurement & Information

21. Questions about the HAPS? Please contact your local LHIN.