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Ontario Health System Funding Reform: Overview. Presentation by: Irene Blais, Director, Funding Unit Date: Wednesday September 11 th , 2013 CAPCA – Chief Operating Officer Roundtable. Agenda. Health System Funding Reform and CCO’s Role Current QBPs Systemic Treatment GI Endoscopy

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Ontario health system funding reform overview

Ontario Health System Funding Reform:Overview

Presentation by: Irene Blais, Director, Funding Unit

Date: Wednesday September 11th, 2013

CAPCA – Chief Operating Officer Roundtable


  • Health System Funding Reform and CCO’s Role

  • Current QBPs

    • Systemic Treatment

    • GI Endoscopy

  • New QBPs

    • Cancer Surgery

    • Colposcopy

  • Q & A

Health Service Providers

(e.g. Community Care

Access Centres, Hospitals)

What is Health System Funding Reform Vision?


Global Funding

  • Evidence-based funding driven based on the highest quality, most efficient care

    • How many patients they look after

    • The services they deliver

    • The evidence-based quality of these services

    • The specific needs of the population they serve

Slide provided by MOHLTC

Funding reform two key components
Funding Reform: Two Key Components

  • Health Based Allocation Model (HBAM)

    • HBAM is a made-in-Ontario model that informs funding allocation to health services providers based on population needs

  • Quality-Based Procedures (QBP)

    • Price x volume, evidence based clinical pathways ensure quality standards

    • Opportunity for process improvements, clinical re-design, improved patient outcomes, enhanced patient experience

  • HSFR: The model

    Recap: An evidence and quality-based framework has identified Quality-Based Procedures that have the potential to both improve quality outcomes and reduce costs

    2013 14 funding allocation update
    2013/14 Funding Allocation Update

    Slide provided by MOHLTC

    Cco orn leading full implementation of quality based procedures including
    CCO/ORN leading full implementation of Quality-Based Procedures including…


    Product Details


    • Quality-Based Procedures’ Definitions

    • Best Practices

    • Better Practice Hospitals

    • Clinical Handbooks

    • Clinical Engagement

    Pricing/ Funding

    • Quality-Based Procedure Best Practice Price

    • Quality Overlay Framework

    Capacity Planning

    • Regional/System Volume Management/Capacity Planning Strategy

    • Capacity Utilization and Forecasting Program

    Monitoring and Evaluation

    • Integrated Quality-Based Procedure Scorecard


    Why is cco part of hsfr
    Why is CCO part of HSFR? Procedures including…

    • Government’s Advisor for Cancer & Renal Services.

    • Principles of equity, evidence-based recommendations, performance-oriented goals, and value for money (help build the best health system in the world)

    • Motivate change through the cause, evidence and data, and funding levers

    • Oversee more than $800 million in patient-based funding

    • Robust clinical leadership model based on regional networks

    • Well-developed evidence review and guideline development processes

    • Well-developed performance management model

    Current qbps systemic treatment
    Current QBPs – Systemic Treatment Procedures including…

    Why reform systemic therapy limitations of the current model
    Why Reform Systemic Therapy? Procedures including…Limitations of the Current Model

    • Systemic Treatment if funded in a variety of ways:

      • RCCs: Lifetime payment triggered by a consultation (C1S)

      • Non-RCCs: Per case (unique patient) or funding per visit in some cases

      • Some facilities receive PCOP funding (per visit)

    • This results in:

      • Inequities: Not all hospitals receive funding for systemic treatment

      • Duplication: In some cases, double-payment exists

    Further treatment

    Funding Provided

    Treatment start



    Patient does NOT require treatment









    $3400 + $3300

    Community Hospital



    How will the new funding model address these limitations
    How will the new funding model address these limitations? Procedures including…

    • Move from a lifetime payment approach to an activity-based bundled payment approach

    • A Bundled payment approach allows funding to follow the patient, thereby:

      • Recognizing incident and prevalent cases

        • Particularly important as survivorship improves

      • Reducing & eventually eliminating inequities in funding

      • Supporting the shared care model (resulting from a consistent/fair funding model)

      • Recognizing the work associated with the delivery of oral chemotherapy regimens

    • Incent for high-quality care:

      • Identifying and funding for appropriate care according to evidence-informed practice

      • Ensuring patients get access to care they need

      • Optimizing use of resources

    Developing a new funding model for systemic treatment is a priority for CCO under the RSTP Provincial Plan released in 2009

    The bundled payment model phased approach
    The Bundled Payment Model- Phased Approach Procedures including…

    Treatment/ Follow-up


    Parenteral Treatment-

    Adjuvant, Curative, Neo-Adjuvant

    Developed & undergoing validation, 2014-15 implementation

    Consultation for Systemic Treatment

    Developed and to be implemented 2014/15

    • Diagnosis/ Staging Bundle

    • For future phase development & implementation

    • Other treatment bundles:

    • - Parenteral Treatment-Palliative

    • Oral Treatment (may be multiple bundles)

    • To be developed for 2014-15 implementation

    Follow-up (may be multiple bundles)

    To be developed for 2014-15 implementation

    Move from a lifetime payment approach to funding for specific bundles of activity to funding that follows the patient

    Validating evidence informed practice
    Validating Evidence- Informed Practice

    Next Steps:

    Incorporate feedback from all DSG Member Review(where appropriate)

    All Practitioner Review (fall 2013)

    Scope of gi endoscopy qbp
    Scope of GI Endoscopy QBP Informed Practice

    • GI Endoscopy Activity in Hospitals (517,788 cases in 2011/12)

    • Colonoscopy Inspection procedures

    • Gastroscopy Inspection procedures

    • Excision/Biopsy/Destruction procedures

    • Other GI Endoscopy: ex. EUS, ERCP and Laser procedures

    • Hospital Care Setting

    • Endoscopy suite

    • Day Surgery Room

    • Inpatient

    • Emergency Room

    • Expenses

    • $139M in hospital direct costs (2011/12)

    • Pathology laboratory is out-of-scope

    • Physician fees are out-of-scope

    Scope of gi endoscopy qbp1
    Scope of GI Endoscopy QBP Informed Practice

    • Evidence gathered during QBP development suggests that the colonoscopy QBP should be expanded to include all endoscopy services:

    • Better patient care when multiple interventions are required

    • Many services performed in the endoscopy suite, and the associated resources, cannot be decoupled

    • The quality agenda for colonoscopy and endoscopy are tightly aligned

    • Economies of scale exist when multiple endoscopy services are preformed together

    • Overlap of funding across the breadth of services provided in an endoscopy suite is substantial

    Scope of gi endoscopy qbp2
    Scope of GI Endoscopy QBP Informed Practice

    • The table above summarizes the number of G.I Endoscopy procedures by procedure combination in each of the 4 identified settings in 2011/12.

    • The 11 procedure combinations are mutually exclusive meaning that a patient encounter can only be mapped to one combination.

    • The total expenses for these procedures are estimated at $139MM based on 2011/12 data

    New qbps cancer surgery
    New QBPs – Cancer Surgery Informed Practice

    Cancer surgery agreements csa to quality based funding qbp
    Cancer Surgery Agreements (CSA) to… Informed Practice Quality Based Funding (QBP)

    • CCO has been advising the Ministry of Health and Long-Term Care on the allocation of incremental funding for cancer surgery procedures since 2004

      • Good progress – decrease in wait times

      • Strong linkage to quality via Schedule B

    • Cancer Surgery is well positioned for transition to QBP

      • Strong quality program & guidelines & pathways

      • Benefit from knowledge gained from CSA process & methodology

    • Disease site approach

      • Prostate will be the initial disease site

      • Unknown – possible that CSA will exist for some disease sites

    Annual cancer surgery volumes 2004 05 2012 13 incremental funding 70mm 2012 13
    Annual Cancer Surgery Volumes Informed Practice2004/05 – 2012/13 (incremental funding $70MM 2012/13)

    Cancer surgery wait times
    Cancer Surgery Wait times Informed Practice

    New qbps colposcopy
    New QBPs – Colposcopy Informed Practice

    Current state colposcopy
    Current State - Colposcopy Informed Practice

    • In Ontario, colposcopies are conducted both in hospitals and also within the community, primarily private practitioner offices and clinics.

    • Based on clinical expert feedback at CCO, variations in practice exist in all settings across the province of Ontario.

    • In addition, a consistent, system-wide approach for accountability over the quality and efficacy of colposcopy services provided does not exist.

    • The 2008 Program In Evidence-Based Care (PEBC) Colposcopy standards (which describe the optimum organization for the delivery of colposcopy services in Ontario) are currently in the process of being revised.

    Current state colposcopy1
    Current State - Colposcopy Informed Practice

    • CCO foresees the need to include both hospitals and community settings in order to appropriately apply these standards across the province of Ontario.

    • Practice variations, as well as the lack of consistent mechanisms for measuring quality, each present an opportunity to increase quality and efficiency across the system by including both hospitals and community settings in the definition of the Colposcopy QBP.

    • The Colposcopy QBP aims to improve quality, decrease wait times and reduce lost-to-follow-up rates.

    Current state colposcopy2
    Current State - Colposcopy Informed Practice

    Next steps policy and strategy
    Next Steps – Policy and Strategy Informed Practice

    • Continued Policy and Strategy development including but not limited to:

      • Cancer funding ‘Think Tank’

      • Funding across multiple sectors including homecare

      • Models of Care

      • Environmental scan

      • Evaluation framework