Systemic Treatment
QBP Level 4 Funding
Working Group
AUGUST 21, 1-3PM
Working Group Regional Members
2
Region Facility Name
Erie St. Clair Windsor Regional Hospital Elizabeth Dulmage
Erie St. Clair Chatham-Kent Health Alliance Nancy Snobelen
South West London Health Sciences Centre Brenda Fleming
South West Listowel Wingham Hospital Alliance Karl Ellis
South West Woodstock General Hospital Fatima Vieira Cabral
Waterloo Wellington Wellington Health Care Alliance Rob Young
Waterloo Wellington Grand River Hospital Donna Van Allen
Waterloo Wellington Guelph General Hospital Jenna Ruttan
Central West Trillium Health Partners Sarah Banbury
Central West Headwaters Health Care Centre Shelley O'Grady
Central West Trillium Health Partners Viannie Lee
South East Kingston General Hospital Kardi Kennedy
South East Lennox and Addington County General Hospital Tracy Kent-Hillis
Champlain The Ottawa Hospital Donna Leafloor
Champlain Renfrew Victoria Hospital Randy Penney
Champlain The Ottawa Hospital Cathy DeGrasse
North Simcoe Muskoka Royal Victoria Hospital Carole Beals
North Simcoe Muskoka Orillia Soldiers' Memorial Hospital Lesley Wesley
North Simcoe Muskoka Royal Victoria Hospital Tracey Keighley-Clarke
North East West Parry Sound Health Centre Anne Litkowich
North East Manitoulin Health Centre Vicky Joncas
North East Health Sciences North Natalie Aubin
North West Riverside Health Care Facilities Inc. Laurie Lundale
North West Thunder Bay Regional Health Sciences Centre Andrea Docherty
Agenda
•Background
•Principles
•Refining the L4 Funding Model
•Approach
•Working Group TOR
•Service Level and Financial Workbook
•Timelines
•Communications Approach
•Additional Feedback and Next Steps
3
ST QBP Model Principles
4
The Systemic Treatment funding model should achieve the following
objectives/adhere to the following overall principles:
• Improve quality of care by aligning funding to defined best practice
• Be patient-centered and ensure that funding follows the patient
• Promote equitable access to patient care services
• Promote fair and equitable funding allocation to institutions
• Promote value for money and improve efficiency (i.e., track and evaluate money
spent by outcomes achieved)
• Promote access to clinical trials where appropriate
• Support new models of care development
• Align funding framework with Ontario’s Excellent Care for All Act & Patient-
Based Payment policy
• Improve outcome measurement and accountability for reported outcomes
• Align physician funding & incentives with funding provided to organization
ST QBP Model Principles
5
The following principles should guide the development and implementation of the new
systemic treatment funding model:
• Strive for a balance between reasonable and perfect
• Ensure model development process is transparent, multi-disciplinary,
collaborative and evidence guided
• Balance implementation of new funding model with financial risk to
organizations
• Ensure that the ongoing governance structure (including clinical oversight) is
supported by transparent dispute resolution processes
• Establish ongoing monitoring, reporting and evaluation of processes/outcomes
• Establish recognized and transparent performance management cycle
• Prevent sudden and significant annual changes to funding
Background
6
STFM Level 4 Working Group – Phase 1: • Determined that significant variation exists in regional models: services provided, data
collection and data quality at level 4 facilities
• Determined that it was not feasible to establish a minimum threshold for treatment
volumes due to limited literature and that CCO should instead identify minimum quality
requirements (work in progress)
• Established a preliminary funding approach
• Identified language to be included in host hospital level 4 agreements
Year 1 STFM Funding Approach Summary:
• All L4 facilities are funded through the host hospital at a rate of $300 per treatment visit
(S1)
• This rate includes an adjustment to account for non-chemotherapy treatment clinic visits
• S1 metric reported by all L4 facilities
• See next slide for more detail
Per Treatment Visit Rate
7
• The following is included in the per-treatment visit calculated rate:
• Average cost of treatment (across all regimens)
• Nursing, pharmacy workload
• Manager/clerical costs
• Non-NDFP drug funding
• The price was then adjusted to account for non chemotherapy-treatment
activities:
• Clinic visits
• Sundry/admin clinic costs
• Infrastructure components
• Future “unbundled” items- hydrations, infusions, transfusions etc.,
RCC/L4 Funding Flow
8
•Funding will be provided once for an episode of care by CCO to the RCC
•Funding will flow from the RCC to the Level 4 facility
Patient comes to RCC
for consult
Patient starts course of
treatment and has 6
treatments at L4 facility
Patient has 6 months of
palliative treatment (1
visit each month) at L4
RCC Receives Consult
Bundle
RCC received funding
for relevant band of the
regimen for course
RCC receives funding for
relevant band for 6
months + Re-consult
Bundle
Of the RCC funding,
RCC provides 6 X
treatment rate to L4
facility
Of the RCC funding,
RCC provides 6 X
treatment rate to L4
facility
CCO funding
to RCC
RCC funding
to L4
EXAMPLE
Feedback on the L4 Approach
9
Other Feedback Regarding Regional Level 4 Models:
• The STFM has engaged in conversations regarding how L4 facilities function within
regional models, including referral patterns, training, education, HHR, RCC support, etc.
• Working groups have been launched in some regions to consider how best to address the
working relations and funding of L4 facilities at the regional level
• High level of interest in provincial level 4 work
• Inconsistencies between L4s in understanding data flow
Feedback from Regions Regarding Funding Approach:
• Funding approach does not adequately address the full scope of activities occurring at L4
facilities, including visits related to oral chemotherapy, supportive care visits, and clinic visits
• Small facilities are challenged to operate within the funding model because of insufficient
resources
Do Working Group members have
additional feedback?
Level 4 Working Group
10
Why a Reconstituted Working Group?
• Ensure broader input from all regions with L4 facilities
• Refine funding model based on additional data gained from the service-level costing
workbook
• Up to 3 members from each region with L4 facilities
Leadership
• Chairs: Mark Hartman (RVP) and Irene Blais (Funding Unit Director)
• Clinical Lead: Dr. Bill Evans
Membership:
• 3-4 additional meetings
Meetings: Do Working Group members have
additional feedback on the Terms of
Reference?
Governance
• The Working Group will advise on the L4 funding approach and those recommendations
will be presented to PLC and ultimately the executive sponsors
Refining the Level 4 Funding Strategy: Goal
11
GOAL: ensure that safe care closer to home is appropriately supported through
the systemic treatment funding model
The Level 4 Working Group will work collaboratively to provide recommendations on
potential refinements to the funding model including:
• Advising on whether multiple funding triggers are required. Potential examples
include:
• Treatment visits (IV vs. non-IV and supportive treatment)
• Clinic visits
• Procedures and services
• Advising on approach for funding required resources to manage level 4 facilities
• Advising on whether level 4 facilities require different funding levels dependent on
volume, treatments and services provided or other factors to be determined
• Advising on communication approaches to level 4 sites
• Addressing other issues related to level 4 funding as they arise
Refining the Level 4 Funding Strategy: Approach
12
Understand activity, variation and costs across level 4 facilities and develop
recommendations for a revised L4 funding strategy. Recommendations will be
guided by results of Service Level and Financial Workbook and feedback from
Level 4 Working Group.
• Service Level and Financial Workbook was piloted with North West LHIN and will
be expanded across all regions.
• Lesson learned: necessary to hold one on one calls with each facility
• Purpose of workbook:
• To understand service models at each facility
• To enhance L4’s understanding of data flow from L4 RCP CCO
• To reconcile available data
• To allow CCO to understand regional variation
• i.e. what activity is actually taking place (treatment, clinic visits,
procedures, etc.) vs. what activity is being reported
• To understand costs
• Facility to confirm accuracy and that data is reflective of systemic
treatment patients only
Do Working Group members have
feedback on the proposed approach?
Service Level and Financial Workbook
13
Tab 1: Explanation of data flow
Thunder Bay accesses regional partner site data and through weekly QA process ensures all
orders are reconciled and completed by location
Thunder Bay extracts data into an ALR file submission (.CSV)
and uploads to web-based application
File goes through several stages of sequential error checking & if
passes is retained by CCO for processing
Data available in iPort
Facility-specific S1 Metric volumes included in STFM
Monthly Operational Report
Data is entered at the point-of-care by Regional Partner Site into the MOSAIQ system (RN
MAR and visit capture in Mosaiq for all chemotherapy
orders)
- Region specific (Northwest example below):
Service Level and Financial Workbook
14
Tab 2: Explanation of ALR metrics & Definitions
• C2S: Follow-up visits
• S1: Systemic Suite Visits – Antineoplastic Parenteral Treatment
• S5: Systemic Suite Visits – Supportive Agents
• S7: Systemic Suite Visits – Transfusion Therapy
• S9: Systemic Suite Visits – Hydration
• S11: Systemic Suite Visits – Venous Access Device and Line Care
• S15: Total Systemic Suite Visits
• S17: Systemic Suite Visits – Oral Antineoplastic Treatment
• S19: Total Antineoplastic Systemic Treatment Visits
Tab 3: Facility L4 data
• CCO will provide a summary of all 2014/15 data and Q1 2015/16 data
Service Level and Financial Workbook
15
Tab 4: Statistical Reconciliation
• Comparison of ALR C2S (Clinic visits) vs. Total MIS Visits based on SR28
• OHRS/MIS: Ontario Healthcare Reporting Standards / Management Information
System
• SR28: Service Recipient 28: identified cancer patients
• Comparison of ALR S1 (total antineoplastic treatment visits) vs. NACRS
with main diagnosis= Z511
• NACRS: National Ambulatory Care Reporting System
• Z511: Chemotherapy Session for Neoplasm
• CCO will provide all data with an explanation of how data compares to various
elements including ALR data including patient-level data
• Facility action: facility asked to review and identify sources of discrepancies
Service Level and Financial Workbook
16
Tab 5: Financial Data • CCO received data from MOHLTC for both hospital-specific OHRS and OCDM
• CCO will populate workbooks and facilities are asked to confirm accuracy and
that data is reflective of systemic treatment patients only
• Includes Revenues and Expenditures
• OHRS: Ontario Hospital Reporting Standards
• OCDM: Ontario Case Distribution Methodology
• Includes Performance Metrics to be used for benchmarking
Tab 6: Procedures and Services Survey • Facilities complete survey with volumes for which procedures and services
take place at L4 facilities
Do Working Group members have feedback on
Workbook components? Would additional
guidance or clarity be helpful?
Service Level and Financial Workbook
17
Proposed approach:
• Regional call with all Level 4s and RCCs to confirm approach for the region
• Individual calls with each facility, CCO and RCC- workbook provided min.1
week in advance
• Facility provided 4 weeks following call to provide feedback
• Follow-up calls may be needed
• Results summarized provincially and per region
Do Working Group members have feedback on
the approach?
Timeline
18
RVP/RD Call
July
2015
Aug 2015
WG meeting. 1
Review work plan & workbook
Facility calls
(guided by workbook)
Sep-Dec 2015
Dec 2015
WG meetings. 2 & 3
Review results of facility
consultations
WG meetings. 4 & 5:
Develop recommendations
Jan-Feb
2016
Feb 2016
Present results to Advisory
Committee + PLC
Communications Approach
19
Communication 1:
Briefing Note +
Webinar to explain the
approach and what to
expect during facility
call?
Communication 2:
Level 4 in-person
session/OTN to
discuss outcomes
and gather further
feedback?
Communication 3:
Revised Funding
Approach Briefing
Note + Webinar?
Discussion: Communication Approach
20
• Has the correct frequency of communication been identified? At the right time points?
• What should be the communication mechanism? Briefing Note? Webinar?
• Should we plan an in-person/OTN session?
General Feedback:
Communication #1:
• What do you view as the key messages for the first communication?
21
Next Steps
• Does the Working Group have additional feedback?
Additional Feedback and Next Steps
• 1-2 meetings scheduled in early December to
review results from facility calls
• 1-2 meetings scheduled in January/February to
develop recommendations
• Or one in-person meeting instead of the above
teleconferences?
• Develop communication #1 and share with Working
Group Members for feedback
• Begin populating workbooks