S

Readiness Assessment

Summary

Strengths Gaps

• regular meetings that include multiple members

• well-established connections within the health link and the LHIN and reaching out to other LHINs, health links

• highlighted areas need clarification, verification or statistics

• electronic linkages between partners

• how we work with organizations outside out SRHL and LHIN

A Broad Coalition and Diverse Leadership

Models19 early-adopter Health Links providing care to almost one million people, through the co-operation of 18 hospitals, 42

primary care groups and over 60 community service providers Cross section of partners

Mental Health Agencies Public Health Units Food Banks Emergency Medical Services Educational Providers Community Social Service

Providers Long Term Care Facilities Police Services

Cross section of coordinators 4 Hospitals 2 CCACs 8 primary care

(FHT/FHO) 4CHCs 1 Community Services

Organization

Metrics for Health Links

– as per Business Plan template

Operational Metrics (Setting the Stage for Coordinated Care Straightaway) 1. Ensure the development of coordinated care plans for all complex patients 2. Increase the number of complex patients and seniors with regular and timely access to a

primary care provider

Results based Metrics(Moving the Needle) 1. Reduce the time from primary care referral to specialist consultation 2. Reduce the number of 30 day readmissions to hospital 3. Reduce the number of avoidable ED visits for patients with conditions best managed

elsewhere 4. Reduce time from referral to home care visit 5. Reduce unnecessary admissions to hospitals 6. Ensure primary care follow-up within 7 days of discharge from an acute care setting

Evaluation Based Metrics (How you’ll know you’ve arrived) 1. Enhance the health system experience for patients with the greatest health care needs. 2. Achieve an ALC rate of 9 per cent or less 3. Reduce the average cost of delivering health services to patients without compromising

the quality of care

Work still to be done

Accuracy of current data

Missing data

Missing partners

Francophone

Aboriginal

Results oriented

Let’s Begin