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In 2008, former Health Minister David Caplan announced the Strengthening Home Care Services in Ontario strategy to focus on CCAC and service provider accountability for the provision of quality home care services, promote better quality health outcomes for Ontario and promote flexibility and innovation in service provision. Linked to this initial strategy, as well as to the Excellent Care for All Act (ECFAA), ICCP first began as an initiative to encourage effective, coordinated services across the client’s journey in Ontario’s health system and to test innovative changes to client services delivery based on integrated client care teams.
ICCP started out as a multi-year initiative that involved developing, implementing, and evaluating CCAC sites to plan the transition to a more integrated client care model, including the innovative element of payment for specific outcomes. With the aid of clinical best practices and quality improvment initiatives, outcome-based approaches to managing care are intended to foster greater accountability, encourage top performance as well as the pursuit of innovation within the care delivery team, all with the aim of improving the value of care for both the client and health care system.
In January of 2012, the current Minister of Health and Long-Term, Deb Matthews in Ontario’s Action Plan for Health Care, offered the impetus for the health system to become “obsessively patient-centred” and to accelerate the move to patient-based funding in home and community care. In order to help deliver on the quality and value principles identified in the Strengthening Home Care Services strategy, the ECFAA and, recently, Ontario’s Action Plan for Health Care, and to support the adoption of a more person-centered, integrated approach to care and service delivery in the home and community sector, ICCP was transitioned from being a separate project and has evolved into a sector strategy for change.
Originally co-sponsored by the Ministry of Health and Long-Term Care, Ontario's Local Health Integration Networks (LHINs), the Ontario Association of Community Care Access Centres, the Collaborative for Health Sector Strategy at the Rotman School of Management at the University of Toronto, with quality improvement and capacity support from Health Quality Ontario, the goal of the initiative was movement towards models of care delivering the greatest value for money spent and is focused on improving health outcomes for clients. Based on Harvard Professor Michael Porter’s work, the three main principles for achieving value-based care are:
- Specialization
- Integration
- Coordination
These principles informed testing in ICCP early implementation sites throughout the province with the intention to informing broader spread.
Integrated care: a client's perspective
In an effort to knit the health system together for clients receiving care in multiple settings or from multiple providers, integrated care models such as ICCP help Ontarians achieve a more seamless experience throughout their entire care journey. Watch one client’s experience with the integrated care approach.
| ICCP accomplishments include the following:
1. Profound understanding of the importance
& benefits of client and caregiver participation in the
design of care, development of individual care plans,
and care delivery.
2. Development of a new, more collaborative
relationship between CCAC
and contracted service providers.
3. Developing of understanding of what integrated
care means, how it looks, where to start its
development and how difficult it is to deliver.
Current health professions' training, health
care culture, or available tools were not
designed to support integrated care.
4. Integral involvement of other community
services to provide holistic are to clients
and their caregivers.
5. Based on leading practices and delivered by
integrated teams, the first tests of outcome
based reimbursement for home care services in Canada.
Although outcome based reimbursement (OBR)
attracts its own attention, it is critical to understand that OBR cannot be successful if it is not predicated upon the other elements of the model (attached), especially best practices and integrated delivery of care.
All of the above are based on many smaller successes,
all achieved through significant
investment of time and human resources by the partners.
Tremendous work has been done by the
ICCP project office at the OACCAC and the
ICCP early adopter teams for wound and palliative care.
The integrated client care work undertaken in
four CCAC and service provider partnerships
within the wound care population is an example
of how early adopters can set the stage for
successful transition to the sector, now planned for this fall.
This experience suggests that with continued sector leadership and engagement, a similar evolution will also be possible in palliative care.
Effective July 1st, 2012, ICCP has evolved
from project status to a sector-wide
approach for change. With support from the OACCAC,
its work and accomplishments will serve to inform
change initiatives in the home and community sector.
It is our intent to build on the excellent work
already underway in order to help us deliver
upon the quality and value principles, focusing on outcome based care targetted to the specific needs of defined populations.
In addition to informing this outcome-based care work, ICCP has been instrumental in informing the collaborative Quality and Value in Home Care initiative supported by the OACCAC. Through this work, we will see our sector embrace population-focused delivery models, mixed funding models and the supports required to reflect these directions.
In the ICCP model, and increasingly within the current climate, it’s becoming clear that sustainable integration is aided by the cultivation of positive relationships. Facilitated by the unique outcome-based payment models being tested in ICCP early implementation sites, integrated care is also about functional integration. This means that the CCAC and service provider relationship involves a discussion about sharing leadership appropriately, as well as mutual agreement about tasks and accountabilities. It’s no surprise then that at the conclusion of the ICCP outcome based payment trial in Ottawa, the need for collaborative relationships was identified as one of the pieces essential for integrated models of care to succeed in practice. Read more here.
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