Integration Legislation

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Integration Legislation Protocols

• A Healthier Tomorrow

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Welcome

• Welcome to the first of six Webcasts in the
  South West LHIN Webcast Series Integration
  Legislation and Protocols
• Why the Webcast series?
• How did we get here?

A Healthier Tomorrow
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The South West LHIN Webcast Series

• Health System Integration January 9, 2009
• Health System Design January 23
• Health Human Resources February 6 (note date
  time change)
• Seniors Adults with Complex Needs February 20
  (note date change)
• Primary Health Care and Chronic Disease
  Prevention Management March 6
• eHealth Strategy March 27

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Objectives for South West LHIN Webcast Series

• Inform partners of LHINs vision, mission,
  values, and health system improvement goals.
• Inform partners of how the Priority Action Teams
  future directions align with the LHIN goals and
  how recently funded projects move us closer to
  the desired state identified by the Priority
  Action Teams.
• Acknowledge contributions of volunteers and
  partners who were actively involved in defining
  the development of the LHINs work.

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Purpose of this Presentation

• Provide an overview of the legislation
• Review definition of integration and types of
  integration
• Develop a better understanding of what the
  legislation, regulation and protocols require
  and
• Provide an overview of resources on South West
  LHIN website.

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Background

• The Local Health System Integration Act, 2006
  (the Act) was passed to
• provide for an integrated health system to
  improve the health of Ontarians through better
  access to high quality health services,
  coordinated health care in local health systems
  and across the province and effective and
  efficient management of the health system at the
  local level by local health integration networks

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Levels of Governance

• The Act has resulted in two levels of governance
  of the local health system

• System level governance the responsibility of
  the LHIN
• Organizational level governance the
  responsibility of the health service provider

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Evolving Roles of Boards in Integration
LHIN Board
HSP Board

• Provide strategic support of the organization for
  LHIN system integration
• Participate in LHIN community engagement and
  initiate community engagement as required for new
  initiatives
• Establish HSP policy direction for integration
  initiatives with others to align with IHSP
• Approve integration initiatives at the level of
  the organization
• Sign accountability agreement with LHIN and
  monitor performance
• Monitor performance and outcomes of integration
  activities

• Provide strategic leadership to health system
  integration
• Lead community engagement
• Establish LHIN decision process and criteria for
  integration initiatives in context of IHSP
• Approve and allocate resources to integration
  initiatives
• Sign accountability agreement with HSP Boards
• Monitor performance and outcomes of IHSP and
  integration initiatives

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Evolving Roles of Management in Integration
HSP Management
LHIN Management

• Design and manage/support LHIN community
  engagement process
• Manage development of IHSP
• Collaborate with HSPs in identifying and
  developing integration initiatives
• Recommend to LHIN Board resources required by
  HSPs to support IHSP implementation and
  integration initiatives

• Design and manage/support HSP community
  engagement process
• Contribute expertise to the development of the
  IHSP
• Collaborate with LHIN and other HSPs in
  identifying and developing integration
  initiatives
• Implement integration initiatives within the
  policy direction/ resources allocated by the HSP
  Board and LHIN Board

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• Our Vision
• A health care system that helps people stay
  healthy, delivers good care to them when they get
  sick and will be there for their children and
  grandchildren
• Our Mission
• The South West LHIN brings people and
  organizations together to build a health care
  system that balances quality, access and
  sustainability
• Our Values
• Compassion, Courage, Evidence Informed,
  Innovation, Integrity, Trust Respect

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South West LHIN System Level Goals

• A Healthier South West LHIN Community
• Equitable Access to Services
• Quality of Care and Service
• Sustainability of the South West Local Health
  System
• Integration of Health Care Delivery

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Defining Integration

• The LHSIA defines integration broadly to include
  a range of activities that enable outcomes that
  are central to the provincial goals

• Improving accessibility of health services to
  allow people to move more easily through the
  health system
• Improving the match between services provided and
  the multiple needs of clients and
• Making the health care system more sustainable
  accountable and promoting service innovation by
  enabling effective and efficient use of system
  resources and capacity.

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Integrate

• As defined in the Act, includes
• To coordinate services and interaction between
  different persons and entities
• To partner with another person or entity in
  providing services or in operating
• To transfer, merge or amalgamate services,
  operations, persons or entities
• To start or cease providing services and
• To cease to operate or to dissolve or wind up the
  operations of a person or entity.

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Definition of Service

• The term service as defined by the Act
• A service or program offered directly to people
  (e.g. home care services)
• A service or program that supports a direct
  service (e.g. laundry services in a hospital)
• A function that supports an organization that
  provides either a direct or a supporting service
  or program (e.g. payroll services that may be
  either within or outside an organization).

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Types of Organizational Integration

• Governance or corporate integration (e.g. merger
  or amalgamation, transfer of funding)
• Administrative integration defined as the behind
  the scenes services that support the
  organizations ability to serve its clients (e.g.
  management, back-office business processes
  (finance, human resources, information
  technology, marketing), planning, policies
  procedures, fund-raising, education)
• Service integration defined as procedures and
  structures that help several agencies coordinate
  their efforts (e.g. implementation of best
  practices, coordination, access models,
  standardized processes, shared care)

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Integration Approaches

• Providing or changing funding (s.25)
• Facilitated, e.g. integration activities
  involving at least one health service provider,
  and facilitated or negotiated by the LHIN (s.25)
• Voluntary, e.g. integration activities
  voluntarily initiated by health service providers
  (s.27)
• Required, e.g. LHIN or ministry may require
  health service providers to provide or cease to
  provide services, or transfer services from one
  location or health service provider (s.26) and
• Ordered by the Minister (s.28).

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Integration Through Funding (s.25)

• The LHIN can
• Provide funding to a HSP to provide services
• Change the amount of funding provided to a HSP to
  reduce services
• Stop funding a HSP
• .. all subject to terms of the MLAA and the
  service accountability between the LHIN and HSP.
• The LHIN can also put conditions on the funding
  provided.

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Facilitated/Negotiated Integration (s.25)

• When a LHIN negotiates or facilitates the
  integration of entities, at least one of the
  entities must be a HSP as defined in the Act.
• The LHIN may negotiate or facilitate the
  integration of services between two or more HSPs
  or between a HSP and an entity that is not a HSP.
• There may be circumstances where public input is
  particularly important and other circumstances
  where the nature of the negotiation warrants
  greater confidentiality.

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Required Integration (s.26)
A LHIN that has made copies of an IHSP available
to the public may, if it considers it in the
public interest to do so, make a decision that
requires one or more HSPs to which it provides
funding, to do any one or more of the following

• To provide all or part of a service or to cease
  to provide all or part of a service
• To provide a service to a certain level, quantity
  or extent
• To transfer all or part of a service from one
  location to another
• To transfer all or part of a service to or to
  receive all or part of a service from another
  person or entity
• To carry out another type of integration of
  services that is prescribed and
• To do anything or refrain from doing anything
  necessary for the HSP to achieve anything under
  the above 5 bullets, including to transfer
  property or to receive property from another
  person or entity in respect of the services
  affected by the decision.

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Integration by the Minister (s.28)
After receiving advice from the LHIN, the
Minister may, if considers in the public interest
to do so, order a HSP that receives funding from
the LHIN, and that carries on its operations on a
for profit or not for profit basis to do any of
the following on or after the date set out in the
order

• Cease operating, to dissolve or wind up its
  operations
• Amalgamate with one or more HSPs that receive
  funding from LHIN and
• Transfer all or substantially all of its
  operations to one or more persons or entities.

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Health Service Provider Role in Integration

• Be aware of the LHIN IHSP
• Provide leadership in pursuing voluntary
  integration initiatives
• Identify opportunities to integrate services
• Work collaboratively with other HSPs to identify
  integration opportunities
• Engage the community in the development of the
  integration plan
• Give notice of voluntary integration to the LHIN
  (s.27)
• Comply with the LHIN integration decision and
• Be accountable to the LHIN and community for the
  outcomes of the integration activity.

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Voluntary Integration

• Ultimately, the South West LHIN is aiming to
  maximize health service providers opportunities
  to initiate voluntary integration initiatives.

• Policy / Flow Chart
• An Overview of Integration
• Health System Improvement/Integration Pre-
• Proposal Form (H-SIP)
• Notice of Voluntary Integration Form (to
• be completed by HSP(s))

Resources on South West LHIN Website
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Questions to Consider in Determining a Voluntary
Integration

• Is there more than one Health Service Provider
  involved?
• Does the initiative have a significant impact on
  patient/client care and on the population of the
  LHIN in terms of such things as access, choice,
  quality, timeliness, continuity and coordination
  of services, and health outcomes?
• Does the initiative have an impact on the
  Accountability Agreement of a Health Service
  Provider?
• Does the initiative have an impact on the
  governance of the Health Service Provider or of a
  program being delivered by the Health Service
  Provider e.g. program transfer?

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Voluntary Integration Flow Chart
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When is an Integration Decision Required?
Under LHSIA, a LHIN is not required to issue an
integration decision when it integrates through
funding. The LHIN must issue an integration
decision in any of the other three circumstances

• When it facilitates or negotiates integration
  involving a HSP
• When it requires a HSP to undertake integration
  and
• When it orders a HSP not to proceed with
  integration.
• (s.252)

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Steps in Issuing an Integration Decision
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Integration Decision Making Process
There are a number of fundamental principals the
LHIN will consider in structuring its integration
decision making protocols

• Public accountability and transparency will
  underlie decision making, demonstrating that the
  health system is governed in a manner that
  reflects the public interest
• Consistency in decision making will be promoted
• Decision making will be evidence based
• Planning for and integrating the local health
  system will be carried out in alignment with
  provincial strategic directions and the IHSP and
• Cooperation and shared responsibility among
  communities, providers, LHIN and government will
  be supported.

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Determining Whether it is in the Public Interest
to Issue an Integration Decision

• Sample questions to consider
• Does the integration promote appropriate,
  coordinated, effective and efficient health
  services?
• Does the integration promote better access to
  high quality health services?
• Does the integration achieve quality improvements
  in clinical outcomes, health service delivery
  and/or system performance?
• Does the integration support person centred
  health care?
• Does the integration promote efficient and
  effective management of local health system to
  ensure sustainability?
• Does the integration ensure value for money?

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Content of an Integration Decision

• The purpose and nature of the decision (with the
  exception of a decision issued under Section 27
  of the Act ordering a HSP not to proceed with
  integration)
• The parties to the decision
• The actions the parties must take/not take,
  including any time period for doing so
• A requirement that the parties develop a human
  resources adjustment plan
• The date on which any transfers of services take
  effect and
• Any other matter the LHIN considers relevant.

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Required Integration Flow Chart
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Integration on the South West LHIN Website
southwestlhin.on.ca
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Integration on the South West LHIN Website
contd..
southwestlhin.on.ca
General Integration Policies
Voluntary Integration Policies
Facilitated Integration Policies
Required Integration Policies
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Determining Whether it is in the Public Interest
to Issue an Integration Decision
This document can be found on the website with
the Integration information
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Reporting on Integration Activities

• MLAA requires LHINs to report on integration
  activities in their annual reports
• LHINs expected to provide progress reports on
  integration activities in second quarter reports,
  summarizing activities to date and planned
  activities to year-end and
• LHINs will be required to report on planned and
  actual reallocations within, between and among
  sectors.

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Key Messages

• The Act places an obligation on LHINs and on
  Health Service Providers to identify
  opportunities to integrate services
• The SW LHIN would like to maximize the
  opportunities for HSPs to initiate voluntary
  integration initiatives and
• We look forward to working collaboratively with
  you through this process and sharing key
  learnings.
• Please contact the appropriate Planning and
  Integration Lead to discuss voluntary integration
  activities you are pursuing. Planning and
  Integration Leads will link with their
  Performance, Contract and Allocations team member
  to address voluntary integration initiatives
  brought forward to the LHIN.

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Key Contacts
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Next Steps

• Further discussion at Area Provider Tables to
• Ensure clarity regarding integration processes
• Consider local integration opportunities
• Identify LHIN-wide strategies to share
  integration examples success stories and
  lessons learned

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Please join us for our next Webcast

• When January 23, 2009
• Time 930am-1100am
• Topic System Level Design
• Details See the South West LHIN Website
  www.southwestlhin.on.ca

• Please note that todays webcast presentation and
  audio will be posted on our website, and
  available for the next year.

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Questions
Dial 1-866-507-1212 and ask for South West
Local Health Integration Network
A Healthier Tomorrow