The Ford government has introduced its health system legislation, The People’s Health Care Act, 2019. As its centerpiece, the legislation will merge 20 major health care provincial agencies, including the 14 Local Health Integration Networks (LHINs) into a single agency called Ontario Health (“the Agency”), and lead to the establishment of localized Ontario Health Teams (“integrated care delivery systems”) to co-ordinate and integrate health care services at the local level.
The government was careful to avoid bold language associated with dramatic transformation. Instead its message focused on continuation and coordination of services and better addressing the needs of patients and families. Of note, Minister Elliott indicated a clear role for technology following the establishment of Ontario Health Teams, including improving access to digital tools such as online access to health records, booking appointments online, and virtual care options.
The release of The People’s Health Care Act, 2019 comes after a leak earlier this month of the government’s draft legislation, as well as the release of the first interim report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine. Once this legislation is passed, changes related to the establishment of Ontario Health and Ontario Health Teams will be implemented through a phased approach to ensure continuity of patient care.
- Ontario Health will be the single agency responsible for implementing the MOHLTC’s health system strategy and will coordinate provincial health agencies and specialized provincial programs to ensure collaboration and effectiveness. The provincial agencies slated for consolidation into Ontario Health include:
- Cancer Care Ontario
- Health Quality Ontario
- eHealth Ontario
- Trillium Gift of Life Network
- Health Shared Services Ontario
- HealthForce Ontario Marketing and Recruitment Agency
- 14 Local Health Integration Networks (LHINs)
- Any other provincial agency that “receives funding from the Ministry or the Agency and that provides programs or services that are consistent with the objects of the Agency” (NOTE: this was not referenced in the announcement by the Minister)
- Ontario Health will be responsible for healthcare system management, performance, quality standards, regional partnerships, oversight, back office support, digital services, and procurement.
- The Minister has the ability to further reform the current system such as integrate, amalgamate, cease operating, or coordinate services, including designating a group of entities as an integrated care delivery system.
- Ontario Health and each health service provider and integrated care delivery system shall separately and in conjunction with each other identify opportunities to integrate to provide “appropriate, coordinated, effective and efficient services.”
Ontario Health Governance
The Minister and Ontario Health will enter into an accountability agreement that will be for more than one fiscal year in length and include:
- Performance goals and objectives for Ontario Health
- Performance standards, targets and measures for Ontario Health
- Requirements for Ontario Health to report on the performance of Ontario Health
- A plan for spending the funding that Ontario Health receives
- A progressive performance management process for Ontario Health
- All other prescribed matters, if any
The legislation provides the Minister with broad-ranging powers, with the ability to issue operational or policy directives and standards that will bind Ontario Health, a health service provider, an Ontario Health Team, or an individual health care provider that receives funding via Ontario Health.
Ontario Health’s Board of Directors will include fifteen members appointed by the Lieutenant Governor in Council and they will serve terms up to three years in length but cannot serve for more than six years. A member will cease their position if the Lieutenant Governor in Council revokes the member’s appointment and if the member dies or resigns.
- The Lieutenant Governor will designate a chair and at least one vice-chair from the existing members of the Board of Directors. The Board will be required to meet at least four times a year and need to achieve quorum (i.e. a majority of the Board of Directors) to conduct the business of the board.
Ontario Health will appoint and employ a Chief Executive Officer (CEO) and their role is to be responsible for the management and administration of the affairs of Ontario Health.
- The CEO will be subject to the supervision and direction of the Board of Directors and will not be permitted to be a member of the Board.
- The CEO of Ontario Health may appoint employees that are considered necessary for the proper conduct of the affairs of Ontario Health.
- The Minister may adjust ranges for the salary and other remuneration of the CEO of Ontario Health, and the Agency shall carry out the adjustments.
The Board of Directors establishes committees by creating a by-law when the Minister issues a regulation to do so.
- The Board will also appoint members of the committees who meet the qualifications and ensure they operate in accordance with requirements as specified in the Minister’s regulation.
The Board of Directors may make by-laws or pass resolutions to appoint officers and assign them such powers and duties as the board considers appropriate.
Ontario Health will be funded by the Minister, and Ontario Health will be responsible for providing funding to health service providers and integrated care delivery systems (via service accountability agreements).
- Given the provincial fiscal context, the intention is to use existing funding more effectively, including sharing and reapportionment of funding.
Ontario Health Teams
Ontario Health Teams will either partner with existing local health care providers to work together to provide coordinated care, or partner with providers serving a specialized patient population such as specialty pediatric or patients with complex health needs.
While specific criteria still needs to be determined, the legislation indicates that Ontario Health Teams need to include at least three of the following types of health care service providers:
- Hospital services
- Primary care services
- Mental health or addictions services
- Home care or community services
- Long-term care home services
- Palliative care services
- Any other prescribed health care service or non-health service that supports the provision of health care services
Ontario Health Teams will be clinically and fiscally responsible for health care service delivery and responsible for funding said services using a single budget determined by the funding received from Ontario Health. Each Ontario Health Team will:
- Manage costs and quality of care
- Know patient health history
- Be aware of health care services in their geographic area
- Help patients navigate the system 24/7
- Ensure patient referrals get to the right place
- Receive and share health records
- Provide patients with digital options, such as online access to health records and virtual care
The government has indicated that additional information (i.e. guidance materials and criteria) regarding how providers can become an Ontario Health Team will be made available in early March and that the selection process will begin that same month. Ontario Health Teams will be established in phases across the province, with early adopters in place by the summer. It is anticipated that there will ultimately be between 30 and 50 Ontario Health Teams serving a specific geographic area, each serving a population up to 300,000 people. The government indicated they will learn from the early adopters and apply the accumulated knowledge to scaling Teams over time.