The following are the highlights of the Champlain Local Health Integration Network Board of Directors meeting held in Ottawa, Ontario on April 26, 2017.
Champlain Home-Care Demand Study - Information
The Champlain Community Care Access Centre (CCAC) coordinates and delivers a range of home and community services across the region. In recent years, the demand for these services has been greater than the available funding could provide. To help manage the demand for its services, the CCAC has sought ways to improve efficiency and prioritized higher-need clients. Despite these efforts, an increasing number of people have been waiting to receive home care services.
|Colin Preyra presents to the LHIN Board.
To understand root causes and identify what it would take to address the growing demand, the Champlain LHIN and Champlain CCAC commissioned a study into the issue. Between November 2016 and February 2017, a LHIN-CCAC joint working group guided the work of external consultants. The working group shared extensive information from a variety of sources with the consultants, like multi-year service data, internal financial reports, demographic and social determinants of health data. The consultants provided the LHIN with its report of findings, Meeting Home Care Needs in the Champlain LHIN – Estimating & Managing CCAC Service Demand, and Colin Preyra (lead consultant) presented highlights of the report to the LHIN Board.
The report’s key findings included:
- There is substantial unmet need for home-care services in the Champlain region, and it is primarily due to inequitable funding. Currently, the LHIN receives $240.5 million to fund home care services. If the Champlain LHIN were funded for home-care using a population-based model, it would receive an additional $31.5 million as its share of provincial home-care investments. If the funding shortfall was addressed, potentially 6,000 more home care clients would receive home-care services.
- Higher costs for contracted patient care services in Champlain also contribute to unmet need. For example, the Champlain CCAC pays 14% more than the provincial average for nursing services based largely on agreements with contracted service providers that were negotiated over 12 years ago. Higher rates mean that fewer services can be provided.
- The Champlain CCAC is very efficient in administrative costs. In fact at 7%, its administrative costs are less than the provincial average. “In our analysis, the Champlain CCAC is as efficient as the other CCACs, and more recent data shows it is more efficient,” said Mr. Preyra.
- The Champlain CCAC is also efficient in its care model and case management model, and has adopted innovative solutions to try to meet demand and reduce costs. For example, compared to any other LHIN across the province, the Champlain CCAC provides more nursing visits in clinics than the rest of the province, (19%, while provincial average is 14%). When patients are seen in a clinic setting instead of at home, the cost is about 50% less because nurses are saving the time needed to travel and set up.
- Community support services, which play a critical role in home care by substituting and complementing CCAC services, are also under-funded in Champlain relative to other regions: 25% per capita less than would be expected.
Board Chair Jean-Pierre Boisclair thanked Mr. Preyra for the work and the report, which is very timely: on May 24, 2017, the Champlain CCAC is merging with the Champlain LHIN, and the LHIN will continue its current mandate while also delivering home and community care services. “This is something we are going to pursue because it is critically important,” Mr. Boisclair said. “We need the tools to effectively manage home-care demand, and fulfill our obligation to the people of the Champlain region.”
In the coming months, the Champlain LHIN will review the report and its recommendations, and develop a list of priorities for action. To see the full home-care report, please scroll through the Board Package (beginning on page 4).
Third Quarter 2016-17 Performance Report
The LHIN’s quarterly performance reports provide insight into Champlain’s health-system performance, based on 14 indicators provided by the Ministry of Health and Long-Term Care (Ministry). These indicators are included in the Ministry-LHIN Accountability Agreements, and include areas such as wait times for various services, the number of patients who have repeat visits within 30-days to the emergency department for mental health conditions, or who are in hospital waiting for an alternate level of care in the community.
The LHIN Board discussed and approved the Third Quarter 2016-17 Performance Report, which was presented by Brian Schnarch, Champlain LHIN Director of System Performance and Analysis.
- When combining performance on all indicators, Champlain is the most improved of the 14 LHINs, year-over-year: last year it was eleventh; now it is fourth.
- The Champlain LHIN achieved targets for hip replacement wait times, wait times for first home-care nursing visit received within five days of receiving the requisition, and repeat hospital re-admissions for certain chronic conditions. Of meeting the target on the indicator related to chronic conditions, Mr. Schnarch said: “This is a great accomplishment for the LHIN, because it is such a vital health-system metric. It touches on hospitals, of course, but also home and community care, primary care, and most importantly, the connections among them working as patients transition out of hospital.”
- The indicator furthest from its target was for MRI scans (45% of the way toward the target). While performance on the MRI scan wait-time indicator is a little better than the provincial average, no LHIN is close to the target. Even so, it is important to note that people who need scans most urgently get them first – in fact, in Champlain, 97% of people with the most urgent need get same-day scans as a result of triaging. However, those with the least urgent need for scans make up the largest part of the demand, and only 25% are seen within the 28-day target. Strategies are being developed in this region to reduce waits for this group.
For the first time, data was presented that compared performance across Champlain’s five sub-regions. It showed that where you live makes a difference. Compared to the region’s overall average:
- Western Ottawa, Eastern Ottawa and Eastern Champlain residents make fewer repeat emergency department visits for mental health issues and problematic substance use, while Central Ottawa residents make more of these repeat visits.
- Eastern Ottawa and Eastern Champlain residents are less likely to be waiting in hospital for a more appropriate care setting, and Central Ottawa residents are more likely to be waiting.
- People in Western Champlain and Eastern Champlain are much more likely to visit the emergency department for less urgent conditions. These findings may partially reflect the unique role that hospitals play in small, rural communities
- Satisfaction with health care that is provided in the community is close to 90%, and does not vary much among sub-regions.
The sub-region data will help to better plan and target strategies to meet local needs.
Board members expressed their gratitude for the work that goes into compiling the report, as the information is a key support to their governance and oversight roles.