1. Multi-Sector Service Accountability Agreements (MSAA

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1. Multi-Sector Service Accountability Agreements (MSAA) Governance Structure

2. Context

3. Community Accountability Planning Submission (CAPS)

a) Changes to the 2018/19 CAPS

b) CAPS Narrative Completion

c) CAPS Narrative Submission

d) Additional Resources

e) CAPS Demo

f) Completing the Submission for 2019/20

4. 2019/20 MSAA Schedules Overview

5. 2019/20 MSAA Indicators Overview

6. CAPS & MSAA Schedules Timelines

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Comprehensive Consultation through Multiple Tables

MSAA Advisory Committee

MSAA Indicators Work Group

MSAA Planning & Schedules

Work Group

SRI Reporting Forms

Work Group

MSAA Legal Counsel Support: LHIN Legal Services Branch

MSAA Secretariat Support: Health Shared Services Ontario

Local MSAA Implementation: MSAA LHIN Leads

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The MSAA Advisory Committee is working toward a new three-year agreement

effective from April 1, 2019 to March 31, 2022.

To support this new agreement the MSAA indicators and schedules have been

refreshed and updated:

• A (Description of Services)

• B (Service Plan)

• C (Reports)

• D (Directive Guidelines and Policies)

• E (Performance) (MSAA Indicator Work Group)

• F (Project Funding Template)

• G (Compliance)

* Note: Final approval from the CEO Council is upcoming and changes may occur.

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Removed four Functional Centres (FC) that changed to Account Headers effective

April 1, 2018:

• 72 5 10 40 COM Clinics/Programs – Therapy Clinic

• 72 5 10 50 COM Clinics/Programs – Chronic Disease Clinic

• 72 5 50 45 COM Health Prom/Educ. & Com Dev – Personal Health and Wellness

• 72 5 50 35 COM Health Prom/Educ. & Com Dev – COM Chronic Disease Education,

Awareness and Prevention

Added six FCs (two New, four Previously reported in one of the FCs above that became

Account Headers in April 2018):

New

• 72 5 10 50 50 Clinics/Programs – Chronic Disease – Cardiac Rehabilitation Clinic

• 72 5 50 45 05 Personal Health and Wellness – General

Existing in Ontario Healthcare Reporting Standards (New to CAPS reporting)

• 72 5 50 45 10 Personal Health and Wellness – Mental Wellness, Personal Health Practices

and Coping Skills

• 72 5 50 45 20 Personal Health and Wellness – Oral Health

• 72 5 50 45 30 Personal Health and Wellness – Healthy Child

• 72 5 50 45 40 Personal Health and Wellness – Youth Development

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Edit Checks Added

• On the Service Selection Screen when a Functional Centre (FC) is selected it must have a

corresponding Transfer Payment Business Entity (TPBE) selected to identify the program

funding to which the service applies.

• If a provider does not select a FC on the Service Selection screen, but completes planned

amounts on the Act Summary screen for that FC, an error will be flagged.

Financial and Service Activity Reporting Pages

• Added columns for Budget for 2020/21 and 2021/22.

- These columns are not locked but do populate from the input into the Budget 2019/20

column E.

• Variance calculations have been added for each line to highlight changes between the

2018/19 CAPS budget (original) and the 2019/20 CAPS budget (proposed).

• The HSP-specific view on the Activity Page now has two options:

- Show the HSP-specific Functional Centres that they have selected along with the

“Mandatory” services.

- Show the HSP-specific Functional Centres that they have selected along with all of the

service lines. This option is available where changes to the Mandatory lines have

occurred after the report was finalized.

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Main Menu

• Added a calculation in Column F that flags any Changes to the budget from 2018/19

CAPS.

• The “Verify Edit Checks” link will show an to the left of the link when there are

any outstanding edit checks that have not been resolved on the Edits worksheet.

• Colour-coded the links to differentiate between General, Financial, and Activity.

• Moved the Financial Summary link to the top of the Financial list.

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The CAPS Narrative has been redesigned to accommodate more detailed collection of

data relating to the services provided by Health Service Providers by sub-region:

• Instructions for completion are contained in the new

CAPS Narrative Guide 2019/20.

• The information provided in the CAPS Narrative will not be included in the final

MSAA.

• Supporting education documents are provided on the Central East LHIN website at:

http://www.centraleastlhin.on.ca/forhsps/SAA%20Resources.aspx

http://www.centraleastlhin.on.ca/forhsps/SAA Resources.aspx



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The CAPS Narrative should be submitted with the CAPS on the Self Reporting

Initiative (SRI) under the “Additional Documents” tab.

The CAPS Narrative should accompany the CAPS. The due date is

November 16, 2018.

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The 2018/19 CAPS Completion Guide contains important information to assist HSPs

in completing the CAPS process. HSPs should refer to the Completion Guide when

completing the 2019/20 CAPS.

The CAPS Guidelines have been updated for 2019/20 to provide additional information

when completing the CAPS.

The CAPS Narrative file (CAPS Narrative – 2019/22) is available to download on the

Central East LHIN site at:

http://www.centraleastlhin.on.ca/forhsps/SAA%20Resources.aspx.




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The new CAPS narrative has two recorded training webinars:

• HSP completion webinar: https://ali.health.gov.on.ca/p32lkvnvizc/

• The CAPS recorded webinar that mirrors the written completion guide:

https://ali.health.gov.on.ca/p9eiv0i80rc/

Detailed step-by-step training is available in the CAPS Completion Guide located on the

Central East LHIN website at:

http://www.centraleastlhin.on.ca/forhsps/SAA%20Resources.aspx

https://ali.health.gov.on.ca/p32lkvnvizc/








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Schedule Title Description

A A1. Description of Services

A2. Population & Geography

Describes the services delivered by the

HSP and the HSP’s client populations

and geography served

B B1. Total LHIN Funding Service

Plan

B2. Clinical Activity – Summary

Describes the financial and statistical

status of the HSP

C Reports Identifies and sets due dates for HSP

reporting

D Directives, Guidelines, Policies &

Standards

Identifies applicable MOHLTC policies

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Schedule Title Description

E 1. Core Indicators Identifies indicators, standards and local

performance requirements 2a. Clinical Activity Detail

2b. CHC Sector Specific

Indicators

2c. CMH&A Sector Specific

Indicators

2d. CSS Sector Specific

Indicators

3a. Local Indicators &

Obligations

F Project Funding Agreement

Template

Template used for funding projects that are

distinct from anything else; a unique project

that has nothing to do with the existing services

within the SAA

G Declaration of Compliance Form completed by the HSP Board of Directors

to declare that the HSP has complied with the

terms of the Agreement

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Schedule Change Rationale

A • Removed and incorporated into a separate

CAPS Narrative

• The information captured is used for LHIN

planning and not relevant to accountability

B • B1: Total LHIN Funding - added

applicable dates for 2019/20

• Updated to reflect 2019/20

• B2: Clinical Activity Summary – removed • The information is redundant as it is a

summary of other information collected

C - CHC • Added applicable reporting dates for

2019/20

• Updated to reflect applicable 2019/20

reporting periods

• Added Community Engagement and

Integration Activities Reporting

• Was added to the MSAA template in 2018/19

C - CMHA • Added applicable reporting dates for

2019/20


reporting periods



• Was added to the MSAA template in 2018/19

• Removed due dates for the Common Data

Set for Community Mental Health

Services (CDS-MH)

• The ministry has deferred the submission of

CDS-MH data starting in fiscal year 2018/19.

See footnote note in schedule.

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C - CMHA

& CSS

• Added applicable reporting dates for

2019/20


reporting periods



• Was added to the MSAA template in

2018/19

C - CSS • Added applicable reporting dates for

2019/20


reporting periods



• Was added to the MSAA template in

2018/19

D - CHC • Added additional directives, polices

and guidelines

• Relevant to sector

D - CMHA

& CSS

• Added additional directives, polices

and guidelines


D - CSS • Added additional directives, polices

and guidelines


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D - CMHA • Added additional directives, polices

and guidelines


E • See indicator slides

F • No change • Section 11 of the Public Sector

Compensation Restraint to Protect

Public Services Act, 2010 is still

applicable

G • Added applicable period • Updated to reflect the applicable

period

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• The work group will be completing an in-depth review of the indicators, technical

specifications, and target setting guidelines.

• It aims to deliver a slate of meaningful and measurable indicators that reflect the

patients’ continuum of care, promotes patient-centred discussions among all the

sectors, and in which each sector can recognize its contribution.

• Recognizing that the work will go beyond the deadlines for the usual refresh

process, the group has expanded its work plan and will continue working through

the remainder of the fiscal year.

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• A technical specification (tech spec) document is developed each year. The tech spec

specifies indicator definitions, calculations, reporting periods, and other technical

information.

• The work group will update the tech spec to more clearly describe and define the

indicators, and will add a section that identifies the CAPS location for ease of

reference.

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• A target setting document is developed each year that provides performance target

and corridor setting methodology to guide consistency and commonality across the

LHINs and health service providers (HSP) when establishing targets.

• The performance target and corridor-setting guideline accompanies the indicator

technical specification document.

Note: Performance targets and corridors are established for performance indicators

only.

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• SAA indicator categories have been updated to reflect recommendations from the

Data and Performance Work Stream.

• As such, indicator decisions have been approached with these new categories in

mind.

Current Categories

• Performance

• Explanatory

• Developmental

New Categories

• Performance

• Monitoring

• Explanatory

• Developmental

• Future*

* Note: Future Indicators would not be included in the SAA

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• Renewed LHIN mandates (based on Patients First)

• Desire for refreshed 2018/19 Ministry/LHIN Accountability Agreement (MLAA) and

SAA indicators

• Need for greater alignment between MLAA and SAAs

• The Institute for Healthcare Improvement’s Triple Aim Framework

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Core Indicators:

• Performance

• Monitoring

• Explanatory

Community Health Centres (CHC) Indicators:

• Performance

• Explanatory

• Developmental

Community Support Services (CSS) Indicators:

• Explanatory

• Developmental

Community Mental Health & Addiction (CMHA) Indicators:

• Explanatory

• Developmental

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• Fund type 2 balanced budget

• Proportion of budget spent on administration

• Variance forecast to actual expenditures (moved to Monitoring)

• Percentage total margin

• Service activity by functional centre

• Variance forecast to actual units of service (moved to Monitoring)

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• Number of Individuals Served (by functional centre) (name changed from Number

of individuals served)

• ALC Rate (moved to ‘Monitoring’)

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• Variance forecast to actual expenditures (moved from Performance)

• Variance forecast to actual units of service (moved from Performance)

• ALC Rate (moved from Performance)

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• Cost per unit of service (by functional centre)

• Cost per individual serviced (by program/service/functional centre)

• Client experience

• Percentage of Alternative Level of Care (ALC) days

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• Number of persons waiting for service (by functional centre)

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• Average number of days waited for first service (by functional centre)

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• Cervical cancer screening

• Colorectal Screening rate

• Inter-professional diabetes care rate

• Influenza vaccination rate

• Breast cancer screening rate

• Retention Rate (for Nurse Practitioners and General Practitioners)

• Access to primary care

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• Client satisfaction – Access

• Clinical support staff per primary care provider

• Interpretation

• Exam rooms per primary care provider

• New grads/new staff

• Non-Primary Care activities

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• Number of new patients

• Number of registered clients

• Specialized care

• Supervision of students

• Third next available appointment (3NAA)

• Non-insured clients

• Travel time (NEW) – This indicator calculates the percentage of total time General

Practitioners, Nurse Practitioners, Physician Assistant, Registered Nurses, and

Registered Practical Nurses spent travelling for the purpose of direct service

delivery to clients.

• High-risk urban population (NEW) – This indicator identifies Community Health

Centres who provide services to a high-risk urban population.

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• CHC clients hospitalized for Ambulatory Care Sensitive Conditions (ACSC)

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• Repeat unscheduled emergency visits within 30 days (for mental health and

substance abuse conditions)

• Average number of days waited from referral/application to initial assessment

complete

• Average number of days waited from initial assessment complete to service

initiation

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• Ontario Common Assessment of Need (OCAN)

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• Ontario Perception of Care (OPOC) Tool for MHA (NEW)

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• Strategic Alignment: The proposed LHIN-specific obligation* reflects the system

perspective and important goals or aspects of the regional or local health system. It

aligns with one or more provincial and/or LHIN system imperatives, and with one

or more health system outcome objectives.

• Focus on Integration: The proposed LHIN-specific obligation* enables greater

integration within and across health sectors at the sub-region or LHIN level, with

an emphasis on seamless transitions in care for patients.

• Focus on Improvement: The proposed LHIN-specific obligation* focuses on

matters related to system outcomes, provider-specific performance, and quality

improvement.

* Note: The proposed LHIN-specific obligation is distinct from existing requirements

and accountabilities.

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Activity Target Dates Responsible

CAPS Launch in SRI for HSPs October 1, 2018 LHIN

CAPS 60 Day Issuance Notice to HSPs October 4, 2018 LHIN

Completed CAPS refresh submitted through SRI to LHINs

* PRELIMINARY October 4 – November 16, 2018 HSP

Send MSAA LHSIA Notices to HSPs Fall 2018 LHIN

LHIN review of CAPS refresh, consultations on MSAA

refresh indicators, population of Schedules, and final MSAA

Schedule amendments

November 19, 2018 –

January 15, 2019 LHIN and HSP

LHIN Boards to endorse MSAA Template (2/3 majority

required) December 1 – 31, 2018 LHIN

LHIN Analysis, Final Negotiations of Indicator Targets, and

final version of CAPS, if necessary * FINAL January 15, 2019 LHIN and HSP

HSP Board approves CAPS January 1 – 31, 2019 HSP

Final MSAA template and Schedules sent to Community

HSPs for Board approval February 1 - 28, 2019 LHIN

HSP-signed MSAA returned to the LHIN March 1 – March 15, 2019 HSP

LHIN Board approval of MSAA with final negotiated

schedules March 31, 2019 LHIN

2019-2022 MSAA takes effect April 1, 2019

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If you have any questions, please contact:

• George Jacob – Senior Analyst, Contract Management, Performance and

Accountability

[email protected]

905-427-5497 (ext. 3264)

• Pauline Rahaman – Senior Analyst, Finance and Risk Management

[email protected]

905-427-5497 (ext. 3223)

mailto:[email protected]

mailto:[email protected]