Breakfast with the Chiefs
This presentation is the property of its rightful owner.
Sponsored Links
1 / 21

David Levine President/CEO Montreal Regional Health Authority 2007 PowerPoint PPT Presentation


  • 68 Views
  • Uploaded on
  • Presentation posted in: General

Breakfast with the Chiefs Strategic Levers for a High-performing Health System Equity issues in funding and delivery : The Montreal Experience Toronto - April 17 2007. David Levine President/CEO Montreal Regional Health Authority 2007. Developing a High-Performing Health System in Quebec.

Download Presentation

David Levine President/CEO Montreal Regional Health Authority 2007

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


David levine president ceo montreal regional health authority 2007

Breakfast with the ChiefsStrategic Levers for a High-performing Health System Equity issues in funding and delivery : The Montreal ExperienceToronto - April 17 2007

David Levine

President/CEO

Montreal Regional Health Authority

2007


Developing a high performing health system in quebec

Developing a High-Performing Health System in Quebec

  • History 1970-2004

  • The Reform

    2.1 Objectives

    2.2 Guiding principles

    2.3 Structural changes

  • Strategic Levers

    3.1 A managed care model

    3.2 Primary care teams

    3.3 Empowerment

    3.4 Performance measures

    3.5 Management contracts

    3.6 Equity funding

    3.7 Purchasing accessibility

  • Conclusion


Developing a high performing health system in quebec1

Developing a High-Performing Health System in Quebec

  • History 1970-2004

    • 5 Canadian principles respected

    • Responsibility for the individual

    • Functioning in silos

    • A problem of continuity

    • A problem of accessibility

    • Repetition of services

    • Hard to move from one level of care to another

    • Performance undefined

    • Payment not linked to performance


Developing a high performing health system in quebec2

Developing a High-Performing Health System in Quebec

  • The Reform

    2.1 Objectives

    • Improve the health and will being of the population (specific mandates)

    • Bring services to the population

      (equitable distribution of services)

    • Facilitate the use of services

      (accessibility, continuity)

    • Manage care for vulnerable clientele


Developing a high performing health system in quebec3

Developing a High-Performing Health System in Quebec

2.2 Guiding principal

  • Populational responsibility

    • Defined population

    • Responsible for the health well-being of that population

    • Responsible for the individuals health and well-being

  • Hierarchical provision of services

    • Regrouping primary care responsibility

    • Clearly refining secondary and tertiary services

    • Reference protocols and corridors of services


Developing a high performing health system in quebec4

Developing a High-Performing Health System in Quebec

2.3 Structural changes

  • A new organization: Health and Social Services Centers (HSSC)

  • A new concept of integrated services through the creation of local services networks

  • Merger of hospitals, local community service center, long term care centers into a single institution

  • 12 HSSC in Montreal, 95 across Quebec


Developing a high performing health system in quebec5

Developing a High-Performing Health System in Quebec

Population : 1,9 million

Budget : 5,2 billion $

Institutions : 97

Installations : 350

Medical clinics : 400

Employees : 90 000

MD specialists: 3 293

General practitioners: 2 223

Nurses: 21 700

Other professionals: 8 000


Developing a high performing health system in quebec6

Developing a High-Performing Health System in Quebec

Mandate of a Health and Social Service Center

  • Manage and evaluate the health and well being of the population

  • Manage the use of services by the population

  • Manage the services offered by each HSSC

  • Develope a local network of care


Developing a high performing health system in quebec7

Developing a High-Performing Health System in Quebec

Local territory

Social economy enterprises

Physicians

(FMG, AMC, medical clinics)

Community pharmacies

Health and Social ServicesCentres :

grouping of one or several CLSCSs, CHSLD, CHSGSs

Community organizations

Youth Centre

Noninstitutional resources

Rehabilitation centre

Other sectors:

education, municipal, justice, etc.

Hospitals that provide

specialized services


Developing a high performing health system in quebec8

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.1 Managed care

    • Chronic care model

      • Chronic care protocal for each disease

      • Support patients self management

      • Multidisciplinary team approach

      • A seamless system

      • Decision tools

      • Information systems for developing registers ans insuring follow-up

      • Involvement of community resources


David levine president ceo montreal regional health authority 2007

Survey of operational practice built

on the Chronic Care Model

  • Which is the most important practice?

    • Leadership

    • Accountability

    • Champions

    • Resources

    • Financial Incentives

    • Provider Feedback

    • Program Evaluation

    • Patient Action Plans

    • Patient Education

    • Guideline Training

    • Provider Alerts

    • AMR

    • Defined Care Path

    • Risk Stratification

    • Registry

    • Outreach and Follow-up

    • Inreach

    • Care Coordination

    • Team-Based Care

    • Cultural Competence

From Improving Chronic Illness Care

Ed Wagner, MD, Group Health Cooperative of Puget Sound


Developing a high performing health system in quebec9

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.1 Managed care

    • Clinical components of a population based managed care model

      • A population health evaluation protocol

      • An individual evaluation protocol

      • Developing clinical protocols of care based of a chronic care model

      • Organization of care

        - Into a multidisciplinary teams responsible

        for a rostered population

        - Corridors of service linking the providers of

        care into a seamless system


Developing a high performing health system in quebec10

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.1 Managed care

    • Restructuring care for a population based

      care model

      • Restructuring nursing home care

      • Restructuring rehab care

      • Restructuring care for the intellectually handicaped

      • Restructuring mental health care

      • Restructuring laboratory services


Developing a high performing health system in quebec11

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.2 A Primary care teams

    • Populational responsibility – Rostered clientel

    • Integration of primary care physicians specialists and health professionals into folly integrated multidisciplinary teams

    • Access to medical technology

    • Use of a manage care model


Developing a high performing health system in quebec12

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.3Empowerment

    • On the determinants of health

    • On healthy living

    • On disease management


Developing a high performing health system in quebec13

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.4 Performance measurement

    • Evaluation of population health

    • Evaluation of clinical performance of primary care teams (England quality outcome frame work)

    • Quality control of secondary and tertiary care

    • Measurement of efficiency add efficacy


Developing a high performing health system in quebec14

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.5 Management contracts

    • Minisitry with the Agency

    • Agency with each institution


Developing a high performing health system in quebec15

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.6 Principals of equity funding

    • Regional equity 221 $ million

    • Terretorial equity – Program funding

      - Population based adjusted for age, sex, income,

      education, cost of services, needs evaluation,

      geography, state of health

      - Redistribution of services : - dialysis

      - chemotherapy

      - rehab

      - mental health


Developing a high performing health system in quebec16

Developing a High-Performing Health System in Quebec

  • Strategic Levers

    3.7 Puchasing acessibility

    • Primary care acessibility

      - Family practice groups and integrated primary care teams

      - Hours of operation add coverage

      - Affiliated medical centers

    • Chirurgical acessibility

    • Diagnostic services

    • Regrouping lab services

    • Purchasing radiology services

    • Purchasing volume


Developing a high performing health system in quebec17

Developing a High-Performing Health System in Quebec

  • Conclusion – The key ingredients

  • A population based managed care model

  • Multidisciplinary primary health care teams

  • Competition for provision of services

  • Management contracts


David levine president ceo montreal regional health authority 2007

Thank You

ISBN 2-89510-223-6

Dépôt légal – Bibliothèque nationale du Québec, 2005

This document is available:

- At Service des technologies et de la diffusion de l’information

Phone (514) 286-6500

- On the Website of the Agency: www.santemontreal.qc.ca


  • Login