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Association of Ontario Health Centres 1

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Welcome

EL Network Webinar

September 29, 2016

1.2 Consent Items Approval


1.2.1 April ED Network Minutes

• Please enter votes now.

2.0 Patients First: Next Steps

Agenda

2.1 Legislation Updates & Key Asks

2.2 LHIN Board Appointee Process

2.3 Transition Period

2.4 Related Updates – Throne Speech and 2016 Mandate Letters


2.1 LEGISLATION UPDATES & KEY ASKS


Legislative Updates

• Legislature was prorogued so that new Throne Speech could be delivered.

• New session started on September 12th.

• The Patients First Act will be re-introduced soon, possibly with some changes incorporated.

• Committee hearings will occur after second reading.

– AOHC is preparing submission & working with Community Health Ontario on joint submission.

• Proposed timelines:

– Bill 210 to be passed by late October.

– Legislative changes to take effect on April 1st, 2017.


Legislative Updates

• AOHC advocacy to-date has achieved some of the changes and wording we want to see in Bill 210.

– E.g. Health equity included as an object.

• But further changes are needed to achieve our vision and to mitigate potential risks, as well as overall reframing to focus on People and Communities First.


Key Asks – Fall Actions To-Date

Joint letters to Minister Hoskins:

1.

– AOHC

– AMHO (Addictions and Mental Health Ontario)

– CMHA Ontario

– OCSA (Ontario Community Support Association)

2. &

– Ontario Chronic Disease Prevention Alliance & alPHa

(Association of Local Public Health Agencies) will likely reinforce same messages.


Action Item: MPP Meetings

• MPP Lobby Kit and all Patients First Information is available on the portal.

• Especially important to meet with MPP if you are in Liberal Cabinet Minister’s riding.


https://aohc.site-ym.com/members/group_content_view.asp?group=141556&id=571644

Key Asks – Objects & Definitions

1. Objectives of the LHINs should be expanded to address health and wellbeing, including an object that addresses health promotion.

LHIN Act should include definitions of: – health – health promotion – health equity

2. MLAAs (Ministry-LHIN Accountability Agreements) should include the responsibility for LHINs to reduce health inequities, and develop and fund health promotion programs.


Key Asks – Objects & Definitions

• Responsibility for Health Promotion needs to be in the LHIN Act and the MLAAs.

• See fact sheet available on the portal in the Patients First section.


https://aohc.site-ym.com/members/group_content_view.asp?group=141556&id=571644

Key Asks – Powers

3. LHINs should not be given the mandate for service delivery, including care coordination.

– Potentially opens the door to Regional Health Authorities in the future…

4. Further consultation with HSPs needed before LHINs get increased powers to carry out investigations and reviews, appoint supervisors, give directives, and impose service accountability agreements on HSPs.

– Community Health Ontario (CHO) joint letter makes this request.


Key Asks – Oral Health

5. The LHINs’ responsibilities should include planning, funding and monitoring publicly funded oral health services as part of integrated health care planning.


FRANCOPHONE UPDATES


Recent Updates

• On September 15, AOHC met with MOHLTC representatives to discuss Patients First implications and next steps.

– Key areas during transition: role of planning entities; 3rd party contracting for LHINs

– Planning a forum/symposium to bring LHINs and Planning Entities together

– Discussed need to set standards for HSPs before give them funding to provide FLS

– Discussed need to have a plan for FLS when numbers are dispersed across many subLHINs


Recent Updates - Continued

• September 29th introductory meeting with new Minister Responsible for Francophone Affairs, Marie-France Lalonde (replacing Madeleine Meilleur).

– Representatives from Centre Francophone de Toronto, CSC de l’Estrie, & Hamilton Niagara CHC, as well as the Francophone representative on the AOHC Board attended.

– Goals: • Build a relationship; • Introduce the Francophone CHC model • Explore synergies between Patients First, her Ministry;

and • Reinforce the understanding of her regulatory powers.


Mandate Letters

September 23rd Mandate Letter for Francophone Affairs: https://www.ontario.ca/page/september-2016-mandate-letter-francophone-affairs

1. Strengthening French-language Services to Promote the Ability of Franco-Ontarians to Access the Services They Need in French

– Emphasis on MOHLTC and Francophone Affairs working closer together

– Streamlining designation processes under the French Language Services Act - encouraged


https://www.ontario.ca/page/september-2016-mandate-letter-francophone-affairs











Mandate Letters – Continued

2. Ensuring that the Policies, Programs and Services Designed and Delivered by the Government and its Public Sector Partners are in Keeping with the Requirements of the French Language Services Act

– Apply a Francophone lens from the early stages of policy and program development; access to services in French needs to be enhanced in the health sector.

– Active offer – encouraged

– Third parties - additional work needed toward ensuring that third parties deliver French-language services as per Regulation 284/111.


Next Steps – Bill 210

• A revised Bill 210 is expected to be released this Fall (initial version was totally silent on Francophone issues and French Language Services (FLS))

• At that point, AOHC will provide input related to:

– Role of French Language Health Planning Entities

– Third Party Regulation

– LHSIA (LHIN Act)

– SubLHINs and SubLHIN planning

– FLS Designation

– CCAC transfer and FLS

– Public Health Units and FLS


2.2 LHIN BOARD APPOINTEE PROCESS


If Patients First Bill is passed

• LHIN Board members will increase from 9 to 12.

• Opportunity for us to encourage people to apply to be on Boards.

• Formal appointment process involves Public Appointments Secretariat, the LHIN Board, local LHIN Nominations Committee, Ministerial decision, Cabinet approval.


Action Item: LHIN Board Appointees

• Each Board will be looking to fill 3 new positions soon.

• Get proactive in identifying suitable candidates.

• Let AOHC know if someone is applying.

• Check if your LHIN has Community Nominations Committee and liaise with them re process to get people nominated.


2.3 TRANSITION PERIOD


25

Patients First and Primary Care

Ontario Primary Care Council September 14, 2016

Ministry of Health and Long-Term Care

Ministry of Health and Long-Term Care

Slide from Sept 14th MOHLTC Presentation to Ontario Primary Care Council:










OPCC VISION FOR PRIMARY CARE


Vision Needed for Primary Care

• This past week, OPCC discussed the need for a united vision (“north star”) for primary care at the sub-LHIN level.

• In response to Ministry reps presentation, OPCC strongly suggested to them the need for this vision.

• Ministry thinks that Patients First is the vision.

• Through the discussion with OPCC, Ministry reps have agreed to work with OPCC on a 1-pager vision for primary care.



OPCC Guiding principles:

1. Primary care is central to the performance of whole health system effectiveness;

2. Planning for the system needs to be based on population needs;

3. Programs and services must be appropriate, accessible, timely, high-quality, comprehensive, continuous, evidence-informed, equitable and culturally competent;

4. Care coordination is a core function of primary care; and

5. Collaborative interprofessional teams working to full scope of practice are key to success.


PROPOSALS FOR SUB-LHIN PLANNING AND DELIVERY


Clarity on Sub-LHIN development varies across the province…

• Sub-LHINs will be the focal point for local collaboration and integration.

• LHINs are currently working on sub-LHIN proposals.

– Many sub-LHIN boundaries will reflect Health Links boundaries, but not everywhere.

– Role of primary care leads and clinical leader/integrated director positions is unclear.

• Environmental scan is in-progress, which will be presented to October Executive Leaders Network meeting, along with next steps.


Monitoring: Hospitals and Specialists

• Concern that hospitals are being positioned to be center of sub-LHINs.

• Concern that some new initiatives are very specialist-oriented, without appropriate involvement of primary health care.

• Examples:

– Dryden

– Rural Health Hubs all have hospital leads

– Project ECHO

– MAID clinics in hospitals for outpatients

– Deputy Minister said too early to endorse PINOT but is driving speciality clinics…


2.4 RELATED UPDATES – THRONE SPEECH & 2016 MANDATE LETTERS


THRONE SPEECH


Throne Speech

• On September 12th, the Lieutenant Governor delivered a speech from the throne: A Balanced Plan to Build Ontario Up for Everyone.

• Announcements included: – Creating 100,000 new

childcare spaces

– Eliminating the HST on hydro bills effective Jan 2017


http://r20.rs6.net/tn.jsp?f=001G4n9MjCaWthjd24n_VMA5-AR4JkJsL6bhBeCelXzALjp4VjGsrbBiAZ-uaQVVsoUP1XCAP5ddeMmaS7aljUYbD-Y-1Zd6WWhGrX0-ODAnHkJERmrCOSec1Tcnmou-SH5ozmnELnhrLOq01c5IRpoL2PxX80TM5U1mSznbM6EePZKC_y842btd9lpOy7PDLrmYhGKXd7GPI3P81NIkk9DbUT-WEgR70DYPjrF1fcoDlYIa0B_-21cWg==&c=4oZXsSWXRrsXcT129BsylzCUagfmQTJybltnE4X5qHPfCsUecujq5w==&ch=-0WG4vXdJVW-lw4CLaYN4bFVQnElx0QncC6LgCc7PG0KNKL_S52_zg==




Health Care Backgrounder

• Patients First legislation to be reintroduced.

• Will deliver on promise to "better coordinate and integrate access to primary care and home and community care for all Ontarians."

• Committed to "ensuring fair compensation and investing in front-line health care professionals."

• Commitment to "improve Indigenous health services and outcomes."

• Mention was also made several other key issues. For example:

– Seniors' access to more affordable prescription drugs

– Expanding and improving home and community care


2016 MANDATE LETTERS TO MINISTERS


MOHLTC Priorities

• Access o Public performance report on PC access o Solutions must reflect equity of access o Implement $222M First Nations Action Plan

• Connect o Capacity planning framework for care provision in most appropriate

settings o Connect/integrate mental health & addictions system o Expand culturally appropriate care for seniors

• Inform o Enhance environmental health

• Protect o Reduce opioid misuse; support for addictions


Indigenous Relations & Reconciliation

• Follow up on Truth & Reconciliation report and “Walking Together Strategy” to end violence against Indigenous women

• Trilateral discussions on Indian Welfare Agreement, Indigenous Child & Youth Strategy, Indigenous Housing Strategy


Housing & MCSS Treasury Board • Develop Basic Income

pilot by spring 2017

• Develop Food Security Strategy

• Deliver on Long Term Affordable Housing Strategy

• Bring in plan for social assistance reform by 2017/18

• Balance Ontario budget by 2017/18

• End of “net zero” compensation negotiations for public sector


QUESTIONS?


3.0 New Briefs

COMMUNITY HEALTH AND WELLBEING WEEK- PEOPLE AND COMMUNITIES FIRST



“One approach they’re highlighting is how they put people and communities first. Each member of the association is governed by community members. These centres are run by the community for the community. In my riding, that’s how it works at Central Community Health Centre in St. Thomas, and this is how it works for other community organizations throughout the province.” - Jeff Yurek, statement at Queen’s Park


Health system transformation needs to adopt a wider focus. It needs to shift from treatment to disease prevention. It means that the Patients First bill needs to achieve a better balance by shifting the focus from treating patients when they are sick, to keeping people and communities healthy - France Gélinas, statement at Queen’s Park

Thunderclap campaign Reached over 100,000 social media users!


Transformative Change in Action Blog


Community Health and Wellbeing Week

• Over 100 events from member centres – Events included:

• Be Well survey data collection blitz

• Art exhibits

• City proclamations

• Community forums

• Cooking classes

• Drum circles

• Neighbourhood walks


Community Health and Wellbeing Week




Cancer screening among CHC clients, by screening type and priority population group, in Ontario 2011/12 to 2012/13


QUESTIONS?


4.0 Resource Management

4.1 COMPENSATION UPDATE


Background

• In the 2016-17 budget, MOHLTC committed $85M to "effectively recruit and retain qualified interprofessional staff in primary care settings."

• At the NPAO conference, 6 months later, on Friday, September 23rd 2016, the Minister reaffirmed the commitment and stated that the funding letters would be issued within weeks.


What does it mean? 1. Base funding investment is retroactive to April 1st 2016.

2. There will be increases to base in 2016-17 and 2017-18. In 2018-19 your compensation budget will be flat lined.

3. All members will receive funding letters within weeks.

– CHCs will receive letters through their LHINs.

– CHCs to receive letters as the same time as other models.

– It will be directed by the MOHLTC to the LHINs that it is flow through.


What is being funded?

GLOBAL INCREASE TO COMPENSATION: Calculations based on:

1. Benefits to increase to 22.5%

2. Health Promoters and Registered Dietitians to be moved from band 7 to 8.

3. NPs salary increase to begin to move toward market exception.

4. Remaining funds to be used to increase salary for all other roles.


Next Steps

• Technical briefings by MOHLTC as soon as funding letters are out. AOHC (as well as NPAO and AFHTO) to setup up webinar to answer membership questions. Details to follow.

• Organizations are expected to submit a report to the MOHLTC/ LHIN by end of Q3 (2016-2017) reporting that all funds were used to address compensation.

• This investment is a stepping stone to 2012 Hay rates. The 3 Associations (AOHC, NPAO and AFHTO) will resume advocacy efforts immediately focusing on 2017-18 budget cycle.


4.4 REGISTERED RESPIRATORY THERAPISTS (RRTS) ROLE EVALUATION


Background and Process

• Registered Respiratory Therapists Society of Ontario (RTSO) approached the Association of Family Health Teams of Ontario (AFHTO) and the AOHC regarding RRTs placement on current grid.

• The associations asked The Hay Group to review and evaluate the RRT role.

• The Hay Group:

– Reviewed an updated RRT job description;

– Interviewed RRTs; and

– Evaluated the role of the RRT using Hay Group’s job evaluation methodology.


Results & Implications

• Hay Group Recommendation: RRTs working in primary care settings be moved from Level 7 to Level 8 on the grid.

• In practice, in CHCs and AHACs, many RRTs are already being compensated at Level 8; some on the lower end of the band and some on the higher end. RRTs in FHTs are funded at Level 8.

• Communication to staff needs to clearly state that any potential increases will not be implemented until funds are available.


Recommendation to Approve

• The Resource Management Committee (RMC) reviewed the Hay Group findings.

• RMC recommends that the ED Network approve the move of RRTs from Level 7 to Level 8.


Discussion & Questions

Please use chat box to input any discussion points or questions.


Motion

Be it resolved that the CHC and AHAC Provincial ED Network approves the move of Registered Respiratory Therapists from Level 7 to Level 8 on the interprofessional primary care team salary grid as prepared by The Hay Group (now Korn Ferry).

• Please enter votes now.


Results of Vote


4.3 M-SAA RENEWAL UPDATE


1 Year Extension

• Current M-SAA agreement (14/17) is extended for another year, with a new expiration date of 03/31/2018.

• Please see Adrianna’s M-SAA ED Communiqués (Sept 12 and Sept 19). If not received, please let us know.

• AOHC requested a copy of any LHIN specific indicators that had not been included in the update provided by the LHIN COLLABORATIVE.

• Feedback already received re: Champlain and SE LHIN specific indicators. They will be shared with the LHIN CEOs chairing M-SAA AC.

• If we do not hear from you, we assume that the local indicators for your LHIN are accurate.


4.2 COMMUNITY FINANCIAL POLICY (CFP)


Positive Feedback

• AOHC and CHC members on the M-SAA AC made recommendations to clarify Community Financial Policy (CFP) as follows:

1. Allow CHCs to request additional in-year funding from their LHIN if demand for services for non-insured clients exceeds annual allocation.

2. Allow physician benefits and pooling.

3. Clarify physician reallocation and return of surplus funds.

• The changes are moving through MOHLTC to LHINs with goal to be approved at the Oct 21 2016 MSAA AC.

• Update and revised CFP to be provided as soon as details available.


COMMUNITY INVESTMENT RENEWAL FUND (CIRF) UPDATE


The Journey

• On April 9 2014 former MOHLTC Minister, Deb Matthews made an official announcement to establish Community Investment Renewal Fund (CIRF) for CHCs, AHACs, NPLCs, CFHTs, mental health and public health. (https://news.ontario.ca/mof/en/2014/04/investing-in-community-health-infrastructure.html)

• $10M CIRF investment was expected over 3 years (2014-2017).

• CIRF - intended as a fund to undergo minor capital and maintenance repairs for less than $1M (e.g. fixing elevators, roofs, windows, alarm systems, etc.)


https://news.ontario.ca/mof/en/2014/04/investing-in-community-health-infrastructure.html











The Journey – Continued

• In December 2015, CIRF project process and guideline summary - presented as part of the “Community Health Capital Programs Policy”

• On September 26 2016, Premier Wynne and Minister Hoskins announced “first round of funding through CIRF” at SRCHC. This is to become a permanent fund.

• 18/ 59 organizations announced are AOHC members (accessing approx $1.2M out of the $4.1M). 16-17 $s only available to HSPs reporting under the LHINs. Separate process will follow for AHACs, NPLCs, CFHTs.

• If you have not received the September 26 AOHC/ Government communiqués, please let us know.


Next Steps

• CHCs are expected to collaborate with their respective LHINs in accessing CIRF $s.

• We will work with HCIB through pilot phase to ensure AHACs, CFHTs and NPLCs are also able to access funds.

• MOHLTC’s Health Capital Investments Branch (HCIB) representatives have requested an opportunity to provide an update at the Executive Leadership Network in-person meeting at Kingbridge (October 25, King City).


4.5 PROPERTY TAX EXEMPTION


Property Tax Exemption Survey

• We are trying to get a better understanding of which members own their properties and still pay property taxes, and which lease and don’t get 40% rebate.

• 60 members did not complete the survey we sent out in May.

• Please complete the survey before Oct 19th

https://www.surveymonkey.com/r/MMWYDZV

• Even if you get 100% rebate for property taxes please complete it.





Property Tax Exemption – IF YOU OWN

• Last year North Hamilton CHC got their property taxes waived through the Superior Court of Justice because they met 3 conditions: (a) they are a charitable corporation; (b) they own, use and occupy their property for relief of the poor; and (c) they are supported in part by public funds.

• MPAC has recognized that this decision applies to all CHCs in Ontario. AOHC will work with MPAC to reach agreement that it also applies to AHACs, CFHTs and NPLCs.

• If your CHC, AHAC, NPLC, CFHT meets these 3 conditions and are still paying property taxes you should contact your local MPAC office to initiate a review and send the required documents.

https://www.mpac.ca/AboutMPAC/CorporateOverview/OfficeMap





Property Tax Exemption – IF YOU LEASE

• Most AOHC members lease their buildings. You should be getting a 40% rebate on property taxes from your municipality/county.

• If you lease your building, have charitable status and are supported by public funds and do not get a 40% rebate on property taxes you should follow up with your local municipal or county administrative offices.


Next Steps

• RMC is interested in launching an initiative to present a case to MPAC that those members who lease their buildings, have charitable status and are supported by public funds should also be eligible for 100% property tax exemption.

• The first step would be to acquire a legal opinion on the chances of success and to develop a plan. AOHC has a fee quote for $10-15,000

• If you are interested in participating and willing to contribute please email [email protected]

• If you can join small working committee let us know.


mailto:[email protected]

QUESTIONS?


5.0 Performance Management / Information Management

5.1 TRANSITION TO PS SUITES TELUS HEALTH UPDATE • PS Suite EMR Site Selection Working Group

• Need 2 Executive Leaders

• PS Suite EMR Validation • RFP compliance review will begin within the

next few weeks

• Apportionment Fees WG Review • Need 2 Executive Leaders

• Leadership


5.2 Performance Management Community Initiatives Resource Tool (CIRT)

Scheduled to GO LIVE on October 20


QUESTIONS?


6.0 Advocacy update


6.1 Dental Petition to Legislative Assembly

• AOHC and the Ontario Oral Health Alliance has launched a new advocacy campaign calling on MPPs to extend public oral health programs to low income adults and seniors, and deliver services through publicly funded dental clinics

• The Dental Petition was sent to Health Promoters with an ask to collect signatures in your riding, then meet with your MPP in the fall asking him/her to table the petitions in the Legislature

• If you haven’t seen the petition please check https://www.aohc.org/oral-health and print it off. Questions? [email protected]


https://www.aohc.org/oral-health




mailto:[email protected]

6.2 OHIP for All campaign

• There are an estimated 500,000 people in Ontario who are denied access to health care due to immigration status.

• Removing barriers to access is one of AOHC’s strategic directions.

• Please support this campaign to extend OHIP to all residents of Ontario by signing the Open Letter to the Premier & Health Minister at http://ohipforall.ca/open-letter-ohipforall/


http://ohipforall.ca/open-letter-ohipforall/






QUESTIONS?


7.0 Update on AOHC’s Design Phase


4D Cycle of Appreciative Inquiry




Discovery Phase: S.O.A.R. Strengths, Opportunities, Aspirations and Results

Dream Phase


• Membership Criteria (our collective identity)

• Branding/Positioning (AOHC’s promise to its members)

• IMS Review

• Network Mapping (how we organize ourselves to work together; recommendations will incorporate results of IMS Review)

• AOHC’s Board Composition (governance design and linkages)

• Indigenous primary health care: from partners to allies.


Design Phase: In Scope

QUESTIONS?


8.0 October 26 – 27th Executive Leaders Network Meeting

Meeting Registration to be circulated this week!

• If you haven’t already, please ensure you book your accommodation directly with Kingbridge.

• Meeting registration will be circulated in the coming week.


Optional Sessions

October 25th (Pre-meeting)

• Community Infrastructure Renewal Fund (CIRF)

– HCIB staff will deliver a presentation and Q&A.

• An Introduction to Harm Reduction

– Delivered by Lynne Raskin and Jason Altenberg from South Riverdale CHC.

*Please RSVP for these sessions when you register for the meeting.

October 26th (Day 1) Evening

• PS Suites Telus Health Demonstration


Day 1 & 2 Agenda Topics

• IMS Review and Multi-EMR questions

• Performance Management Program

• Community Initiatives Resource Tool (CIRT) Demo and How Executive Leaders Can Use it

• AOHC Renewal and Refresh

• Tetley Reads the Tea Leaves

• People and Communities First Initiatives

• Who we serve & how


Day 1 Evening

• 2 Firebowls booked for after dinner on Day 1 (weather permitting)

• If you play an instrument, please bring it along to play around the fire!!


9.0 Adjournment

• Please complete webinar evaluation, which will pop up as you close this session.

• Look out for Executive Leaders Network meeting registration.



Thank you. Merci.

Miigwech. Hai Hai.

Nia:wen.

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