The newly enacted Connecting Care Act, 2019 (CCA) enables the designation by the Minister of Health and Long-Term Care (Minister) of integrated care delivery systems called Ontario Health Teams (OHTs).
While the Ministry has provided guidance on minimum governance requirements for OHTs, it makes clear that governance arrangements for OHTs will be "self-determined and fit for purpose".
There are many options for OHT governance and each has pros and cons depending on the circumstances. There is no one-size-fits all answer. The right fit will depend on many different factors.
OHTs may start with one model and evolve to greater governance integration as trust increases and as new members are added.
What is an Ontario Health Team?
An OHT is a person or group of persons or entities designated by the Minister. To be designated, the person, entity or group must meet any prescribed conditions or requirements set out in regulations (to be established) and have the ability to deliver, in an integrated and co-ordinated manner, at least three of the following services:
- Hospital services
- Primary care services
- Mental health or addictions services
- Home care or community care services
- Long-term care home services
- Palliative care services
- Other prescribed services
Becoming an OHT
The Ministry Guidance also outlines a process and timeline for the Ministry's open invitation to providers to become OHTs, including:
- Required components of the OHT model
- Expectations for OHTs at maturity
- Readiness criteria and year one expectations
- Assessment process that recognizes a continuum of readiness which includes "Ready" (OHT Candidates), and "In Discovery" and "In Development" states
The assessment process is expected to continue in phases until full provincial coverage of OHTs is achieved. The timeline for the first round of assessments, as well as other information, resources, and updates is available at: http://health.gov.on.ca/en/pro/programs/connectedcare/oht/
Preference will be given to submissions that include a minimum of hospital, home care, community care and primary care (inter-professional primary care models and physicians). Physician participation is voluntary, but the Ministry's vision is for physicians to play leadership roles and function as core members of OHTs. The current vision is for OHTs to be built on existing physician remuneration models.
The CCA does not prescribe any governance model for OHTs. The Ministry Guidance makes it clear that there is no specified model, OHTs "are free to determine the governance model that works for them," and that governance arrangements are to be "self determined and fit for purpose". However, the Ministry Guidance does specify some minimum governance requirements for OHTs, from readiness through maturity:
- Governance structures will include patients
- Physician and clinical leaders are to be included as part of the leadership and/or governance structure
- Governance model must be conducive to coordinated care delivery, support achievement of performance targets, and enable achievement of accountability objectives
- Must demonstrate strong financial management and controllership to oversee integrated funding envelope
- Must reflect a central brand
- If OHT consists of multiple providers there must be formal agreement(s) and reporting obligations
The following matters are also identified in the Ministry Guidance:
- There will be an agreement with the Ministry and the OHT outlining service delivery and performance obligations
- Existing funding and service agreements with the Ministry will remain in place initially (and possibly beyond), but funding obligations may be reviewed to determine what should continue and what may be revisited, with a view to reducing reporting obligations
- Physician and clinical engagement plan is required to be implemented
- There is to be a strategic plan or strategic direction for the OHT consistent with the central vision and target outcomes for the OHT
A summary checklist of the required elements for OHT governance is attached.
Continuum of Governance Options
Governance options for OHTs to fulfil the Ministry's requirements fit along a continuum, as illustrated below. An OHT can be a single entity or comprised of multiple entities, as long as it provides three or more of the specified services.
While an informal arrangement among two or more providers (e.g., undocumented or documented with a non-binding Memorandum of Understanding) may otherwise allow for service integration/coordination, it will not likely meet the Ministry's required structure to be treated as an OHT.
The Ministry Guidance is clear that a written agreement will be required if two or more entities are involved in forming an OHT; however, there is a spectrum of different arrangements, from less interdependent to more interdependent, which will fulfill this requirement. Each will have pros and cons and may be more or less suitable depending on the circumstances.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.