Expression of Interest for Integrated
Funding Models
Template
Note: the italics in this template provide instructions for completion. Please delete the
italics before submitting your EOI.
Name of Project Team:
[Insert a short title to describe the proposed integrated funding model]
Collaborating organizations and key contact
Collaborating Organizations:
Primary Contact:
position:
phone & email:
Associated LHIN:
[List all collaborating organizations. Should
include ALL organizations impacted by the
project]
[List the name of the primary contact]
[List the title of the primary contact]
[List the phone number and email address of
the primary contact]
[List the name of the relevant LHIN]
Overview of population and care pathway
Population to be served
Describe the target population of focus and estimate the number of patients in the
target population. For the first wave, the focus will be on patients that receive hospital
care and require care in the home for a limited time period ("short-stay"). However,
other proposals that include other providers and models will be considered for future
waves.
Some examples include (but are not limited to):

Population with limited/no existing community care that could safely be shifted
from acute to post-acute settings, such as:
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o Patients who are admitted for stroke and require home care for 60 days
following hospital discharge
o Chronic Diseases such as COPD or CHF with patients at high risk for
readmission
Current care pathway
Describe the existing care pathway(s) (e.g., current pathway(s) patients in the target
population would experience, from hospital admission/discharge to assessment for postacute care, to intake and discharge from post-acute care).
Provide baseline data for the target population going through the current care
pathway(s), using indicators of health outcomes, health care utilization, etc. Please
include comparisons to evidence-based benchmarks for the indicators. Examples of
indicators include:
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Hospital readmission rates
ED visits
Hospital length of stay
ALC
Patient experience
Wait time for home care services
Primary care visit within 7 days of discharge
Medication reconciliation at discharge
Case Costing
Opportunities for improvement
Describe (at a high level – more details to be included below) the proposed care
pathway(s) and how it differs from the current state (NOTE: Teams will be assessed on
readiness to implement their care pathway(s), but care pathway(s) do not need to be at
the implementation stage to be considered).
Key commitments
1. Service delivery model
Describe the proposed service delivery model, including:
a. The types of services included in the care pathway(s).
b. How patients’ assessment of care needs will be determined.
c. How the target population will be defined for inclusion in the project.
d. How each patient’s single care plan will be developed, monitored, and evaluated
in partnership with the team, patient, and family.
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e. How the discharge process from each involved sector will be conducted.
f. How patients will be transitioned to appropriate long-term community-based
care as-needed (e.g., ensuring that patients with chronic diseases are not
excluded).
g. How the new approach is in accordance with regulatory/legislative requirements
OR how current legislation might be challenged by the new approach.
h. What is the geographic distribution of the target population.
2. Integrated payment
Provide details of how existing base funding across providers (such as hospitals, CCACs,
direct service home care providers, physicians, and others) will be leveraged for service
delivery.
Describe the plan to transition to integrated funding once an integrated care process has
been established.
3. Patient/Family engagement
Describe the plan to engage patients and families in the process of developing,
implementing, and evaluating the project.
Describe how patients’ preferences and participation in planning of services will be
accounted for and measured.
4. Commitment to evaluation and continuous quality improvement
a. By checking the box below, we agree to participate in, and support, a central
evaluation of the project. This includes willingness to amend elements of the
intervention design to accommodate the evaluation and using quality
improvement supports and frameworks to support change management.
☐
b. By checking the box below, we agree to provide and/or review data as part of
the central evaluation, including:
 Quality indicators, including patient experience surveys
 Individual-level data to track which patient received which services (including
a plan to obtain patient consent on data linkage for the purpose of provincial
evaluation)
 Patient-reported outcome measures
 Home care activity and assessment
 Case costing data, where applicable
 Discharge Abstract Database (DAD), National Ambulatory Care Reporting
System (NACRS)
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☐
c. By checking the box below, we agree to participate in knowledge translation
with other sites, including participation in a Community of Practice.
☐
5. Implementation and outcomes
Project Implementation
Describe how you intend to implement your project, including goals, deliverables, and
timelines. Please provide a contingency plan including risk and mitigation tactics.
Roles and Responsibilities
Describe the roles and responsibilities of all participating providers.
Measurement of Outcomes
Describe your plan to measure progress (e.g., rate of implementation, success of patient
recruitment, degree of care and payment integration across sectors), process (e.g., type
and volume of services provided to patients at individual-level) and outcomes (e.g., use
of standardized measures and outcomes including hospital readmission, ED visits,
hospital length of stay, ALC length of stay, patient experience, etc.).
Resource plan
Budget
Provide a budget, indicating anticipated project-related expenditures (Note: It is
expected that annual (one-time) project-related costs will be approximately $175,000
per team. This project will not pay for direct service delivery, including case management
and care coordination services. Direct service delivery costs will be drawn from existing
funding among the organizations participating, i.e. no net new funds will be provided). It
is expected that term of the agreements will be a maximum 36 months.
Sustainability
Please describe the plan to ensure the project can continue beyond the funding period.
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Capacity, governance, and buy-in
Capacity
Please describe the team’s current experience with integration initiatives (e.g., how
experience can be leveraged).
Please describe the team’s current experience with quality improvement methodologies
(e.g., participation in IDEAS, LEAN, IHI, etc.).
Governance
Please describe how the respective boards and quality committees of participating
organizations have been involved and engaged in the development of this proposal.
Stakeholder commitment
Describe key stakeholder support for integrated pathway development and/or
implementation, including: physician leads, clinical leadership, most relevant clinicians,
and other providers that are not directly involved but may be impacted by the project.
Sign-off
☐ The LHIN supports this EOI for further consideration (e.g. readiness assessment) and
has consulted with relevant stakeholders (e.g. CCAC and CSS)
The following team members endorse this Expression of Interest:
Name of team member
Title
Affiliated organization
name and address
Signature
[Provide information on
the primary contact]
[Provide information on
the CEO/Executive
Director and Board Chair
from each organization
affected by the project]
[Templates must be submitted to IFM@ontario.ca by March 18, 2015.]
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