Systemic Treatment

QBP Level 4 Funding

Working Group

AUGUST 21, 1-3PM

Working Group Regional Members

2

Region Facility Name

Erie St. Clair Windsor Regional Hospital Elizabeth Dulmage

Erie St. Clair Chatham-Kent Health Alliance Nancy Snobelen

South West London Health Sciences Centre Brenda Fleming

South West Listowel Wingham Hospital Alliance Karl Ellis

South West Woodstock General Hospital Fatima Vieira Cabral

Waterloo Wellington Wellington Health Care Alliance Rob Young

Waterloo Wellington Grand River Hospital Donna Van Allen

Waterloo Wellington Guelph General Hospital Jenna Ruttan

Central West Trillium Health Partners Sarah Banbury

Central West Headwaters Health Care Centre Shelley O'Grady

Central West Trillium Health Partners Viannie Lee

South East Kingston General Hospital Kardi Kennedy

South East Lennox and Addington County General Hospital Tracy Kent-Hillis

Champlain The Ottawa Hospital Donna Leafloor

Champlain Renfrew Victoria Hospital Randy Penney

Champlain The Ottawa Hospital Cathy DeGrasse

North Simcoe Muskoka Royal Victoria Hospital Carole Beals

North Simcoe Muskoka Orillia Soldiers' Memorial Hospital Lesley Wesley

North Simcoe Muskoka Royal Victoria Hospital Tracey Keighley-Clarke

North East West Parry Sound Health Centre Anne Litkowich

North East Manitoulin Health Centre Vicky Joncas

North East Health Sciences North Natalie Aubin

North West Riverside Health Care Facilities Inc. Laurie Lundale

North West Thunder Bay Regional Health Sciences Centre Andrea Docherty

Agenda

•Background

•Principles

•Refining the L4 Funding Model

•Approach

•Working Group TOR

•Service Level and Financial Workbook

•Timelines

•Communications Approach

•Additional Feedback and Next Steps

3

ST QBP Model Principles

4

The Systemic Treatment funding model should achieve the following

objectives/adhere to the following overall principles:

• Improve quality of care by aligning funding to defined best practice

• Be patient-centered and ensure that funding follows the patient

• Promote equitable access to patient care services

• Promote fair and equitable funding allocation to institutions

• Promote value for money and improve efficiency (i.e., track and evaluate money

spent by outcomes achieved)

• Promote access to clinical trials where appropriate

• Support new models of care development

• Align funding framework with Ontario’s Excellent Care for All Act & Patient-

Based Payment policy

• Improve outcome measurement and accountability for reported outcomes

• Align physician funding & incentives with funding provided to organization

ST QBP Model Principles

5

The following principles should guide the development and implementation of the new

systemic treatment funding model:

• Strive for a balance between reasonable and perfect

• Ensure model development process is transparent, multi-disciplinary,

collaborative and evidence guided

• Balance implementation of new funding model with financial risk to

organizations

• Ensure that the ongoing governance structure (including clinical oversight) is

supported by transparent dispute resolution processes

• Establish ongoing monitoring, reporting and evaluation of processes/outcomes

• Establish recognized and transparent performance management cycle

• Prevent sudden and significant annual changes to funding

Background

6

STFM Level 4 Working Group – Phase 1: • Determined that significant variation exists in regional models: services provided, data

collection and data quality at level 4 facilities

• Determined that it was not feasible to establish a minimum threshold for treatment

volumes due to limited literature and that CCO should instead identify minimum quality

requirements (work in progress)

• Established a preliminary funding approach

• Identified language to be included in host hospital level 4 agreements

Year 1 STFM Funding Approach Summary:

• All L4 facilities are funded through the host hospital at a rate of $300 per treatment visit

(S1)

• This rate includes an adjustment to account for non-chemotherapy treatment clinic visits

• S1 metric reported by all L4 facilities

• See next slide for more detail

Per Treatment Visit Rate

7

• The following is included in the per-treatment visit calculated rate:

• Average cost of treatment (across all regimens)

• Nursing, pharmacy workload

• Manager/clerical costs

• Non-NDFP drug funding

• The price was then adjusted to account for non chemotherapy-treatment

activities:

• Clinic visits

• Sundry/admin clinic costs

• Infrastructure components

• Future “unbundled” items- hydrations, infusions, transfusions etc.,

RCC/L4 Funding Flow

8

•Funding will be provided once for an episode of care by CCO to the RCC

•Funding will flow from the RCC to the Level 4 facility

Patient comes to RCC

for consult

Patient starts course of

treatment and has 6

treatments at L4 facility

Patient has 6 months of

palliative treatment (1

visit each month) at L4

RCC Receives Consult

Bundle

RCC received funding

for relevant band of the

regimen for course

RCC receives funding for

relevant band for 6

months + Re-consult

Bundle

Of the RCC funding,

RCC provides 6 X

treatment rate to L4

facility

Of the RCC funding,

RCC provides 6 X

treatment rate to L4

facility

CCO funding

to RCC

RCC funding

to L4

EXAMPLE

Feedback on the L4 Approach

9

Other Feedback Regarding Regional Level 4 Models:

• The STFM has engaged in conversations regarding how L4 facilities function within

regional models, including referral patterns, training, education, HHR, RCC support, etc.

• Working groups have been launched in some regions to consider how best to address the

working relations and funding of L4 facilities at the regional level

• High level of interest in provincial level 4 work

• Inconsistencies between L4s in understanding data flow

Feedback from Regions Regarding Funding Approach:

• Funding approach does not adequately address the full scope of activities occurring at L4

facilities, including visits related to oral chemotherapy, supportive care visits, and clinic visits

• Small facilities are challenged to operate within the funding model because of insufficient

resources

Do Working Group members have

additional feedback?

Level 4 Working Group

10

Why a Reconstituted Working Group?

• Ensure broader input from all regions with L4 facilities

• Refine funding model based on additional data gained from the service-level costing

workbook

• Up to 3 members from each region with L4 facilities

Leadership

• Chairs: Mark Hartman (RVP) and Irene Blais (Funding Unit Director)

• Clinical Lead: Dr. Bill Evans

Membership:

• 3-4 additional meetings

Meetings: Do Working Group members have

additional feedback on the Terms of

Reference?

Governance

• The Working Group will advise on the L4 funding approach and those recommendations

will be presented to PLC and ultimately the executive sponsors

Refining the Level 4 Funding Strategy: Goal

11

GOAL: ensure that safe care closer to home is appropriately supported through

the systemic treatment funding model

The Level 4 Working Group will work collaboratively to provide recommendations on

potential refinements to the funding model including:

• Advising on whether multiple funding triggers are required. Potential examples

include:

• Treatment visits (IV vs. non-IV and supportive treatment)

• Clinic visits

• Procedures and services

• Advising on approach for funding required resources to manage level 4 facilities

• Advising on whether level 4 facilities require different funding levels dependent on

volume, treatments and services provided or other factors to be determined

• Advising on communication approaches to level 4 sites

• Addressing other issues related to level 4 funding as they arise

Refining the Level 4 Funding Strategy: Approach

12

Understand activity, variation and costs across level 4 facilities and develop

recommendations for a revised L4 funding strategy. Recommendations will be

guided by results of Service Level and Financial Workbook and feedback from

Level 4 Working Group.

• Service Level and Financial Workbook was piloted with North West LHIN and will

be expanded across all regions.

• Lesson learned: necessary to hold one on one calls with each facility

• Purpose of workbook:

• To understand service models at each facility

• To enhance L4’s understanding of data flow from L4 RCP CCO

• To reconcile available data

• To allow CCO to understand regional variation

• i.e. what activity is actually taking place (treatment, clinic visits,

procedures, etc.) vs. what activity is being reported

• To understand costs

• Facility to confirm accuracy and that data is reflective of systemic

treatment patients only

Do Working Group members have

feedback on the proposed approach?

Service Level and Financial Workbook

13

Tab 1: Explanation of data flow

Thunder Bay accesses regional partner site data and through weekly QA process ensures all

orders are reconciled and completed by location

Thunder Bay extracts data into an ALR file submission (.CSV)

and uploads to web-based application

File goes through several stages of sequential error checking & if

passes is retained by CCO for processing

Data available in iPort

Facility-specific S1 Metric volumes included in STFM

Monthly Operational Report

Data is entered at the point-of-care by Regional Partner Site into the MOSAIQ system (RN

MAR and visit capture in Mosaiq for all chemotherapy

orders)

- Region specific (Northwest example below):

Service Level and Financial Workbook

14

Tab 2: Explanation of ALR metrics & Definitions

• C2S: Follow-up visits

• S1: Systemic Suite Visits – Antineoplastic Parenteral Treatment

• S5: Systemic Suite Visits – Supportive Agents

• S7: Systemic Suite Visits – Transfusion Therapy

• S9: Systemic Suite Visits – Hydration

• S11: Systemic Suite Visits – Venous Access Device and Line Care

• S15: Total Systemic Suite Visits

• S17: Systemic Suite Visits – Oral Antineoplastic Treatment

• S19: Total Antineoplastic Systemic Treatment Visits

Tab 3: Facility L4 data

• CCO will provide a summary of all 2014/15 data and Q1 2015/16 data

Service Level and Financial Workbook

15

Tab 4: Statistical Reconciliation

• Comparison of ALR C2S (Clinic visits) vs. Total MIS Visits based on SR28

• OHRS/MIS: Ontario Healthcare Reporting Standards / Management Information

System

• SR28: Service Recipient 28: identified cancer patients

• Comparison of ALR S1 (total antineoplastic treatment visits) vs. NACRS

with main diagnosis= Z511

• NACRS: National Ambulatory Care Reporting System

• Z511: Chemotherapy Session for Neoplasm

• CCO will provide all data with an explanation of how data compares to various

elements including ALR data including patient-level data

• Facility action: facility asked to review and identify sources of discrepancies

Service Level and Financial Workbook

16

Tab 5: Financial Data • CCO received data from MOHLTC for both hospital-specific OHRS and OCDM

• CCO will populate workbooks and facilities are asked to confirm accuracy and

that data is reflective of systemic treatment patients only

• Includes Revenues and Expenditures

• OHRS: Ontario Hospital Reporting Standards

• OCDM: Ontario Case Distribution Methodology

• Includes Performance Metrics to be used for benchmarking

Tab 6: Procedures and Services Survey • Facilities complete survey with volumes for which procedures and services

take place at L4 facilities

Do Working Group members have feedback on

Workbook components? Would additional

guidance or clarity be helpful?

Service Level and Financial Workbook

17

Proposed approach:

• Regional call with all Level 4s and RCCs to confirm approach for the region

• Individual calls with each facility, CCO and RCC- workbook provided min.1

week in advance

• Facility provided 4 weeks following call to provide feedback

• Follow-up calls may be needed

• Results summarized provincially and per region

Do Working Group members have feedback on

the approach?

Timeline

18

RVP/RD Call

July

2015

Aug 2015

WG meeting. 1

Review work plan & workbook

Facility calls

(guided by workbook)

Sep-Dec 2015

Dec 2015

WG meetings. 2 & 3

Review results of facility

consultations

WG meetings. 4 & 5:

Develop recommendations

Jan-Feb

2016

Feb 2016

Present results to Advisory

Committee + PLC

Communications Approach

19

Communication 1:

Briefing Note +

Webinar to explain the

approach and what to

expect during facility

call?

Communication 2:

Level 4 in-person

session/OTN to

discuss outcomes

and gather further

feedback?

Communication 3:

Revised Funding

Approach Briefing

Note + Webinar?

Discussion: Communication Approach

20

• Has the correct frequency of communication been identified? At the right time points?

• What should be the communication mechanism? Briefing Note? Webinar?

• Should we plan an in-person/OTN session?

General Feedback:

Communication #1:

• What do you view as the key messages for the first communication?

21

Next Steps

• Does the Working Group have additional feedback?

Additional Feedback and Next Steps

• 1-2 meetings scheduled in early December to

review results from facility calls

• 1-2 meetings scheduled in January/February to

develop recommendations

• Or one in-person meeting instead of the above

teleconferences?

• Develop communication #1 and share with Working

Group Members for feedback

• Begin populating workbooks