2014-17 Multi-Sector Service Accountability
Agreement (M-SAA)
An Overview
Presentation to: HNHB LHIN Health Service Providers
January 15, 2014
1
2014-2015 HNHB LHIN
Integrated Service Delivery Landscape
2014-2015
55 - Community Support Service
Agencies
33 - Community Mental Health and
Addiction Agencies
7- Community Health Centres
1 - Community Care Access Centre
2
What is an M-SAA?
•
Prior to providing funding for the provision of services to its local health system,
the Local Health System Integration Act, 2006 requires that the LHIN and the
Health Service Provider (HSP) enter into a service accountability agreement.
•
The Multi-Sector Accountability Agreement (M-SAA) is a multi-year agreement.
•
It supports a collaborative relationship between the LHIN and the HSP to improve
the health of Ontarians through better access to high quality health services, to
co-ordinate health care in local health systems and to manage the health system
at the local level effectively and efficiently.
•
The HSP and the LHIN agree that the provision of services to the local health
system by the HSP will be funded as set out in this Agreement
For a Summary of Key Changes between Current and new M-SAA, see Appendix 1
3
M-SAA Components
The M-SAA has two components:
The Terms and Conditions and the following Schedules that relate to program
planning, reporting and evaluation:
•
Schedule A: Description of Services
•
Schedule B: Service Plan (HSP’s Operating Plan and Budget)
•
Schedule C: Reports
•
Schedule D: Directives; Guidelines and Policies
•
Schedule E: Performance (including Performance Indicators)
•
Schedule F: Project Funding Agreement Template
•
Schedule G: Compliance
-See Appendix 4 and 5 for more details4
LHIN/HSP Accountability Relationship
Community
Accountability
Planning
Submission
(CAPS)
Multi-sector
Service
Accountability
Agreement
(M-SAA)
Quarterly Report
(Ontario
Healthcare Report
Standards (MIS)
Remediation
Negotiation,
Implementation of
Consequences
Planning
Commitment
Measurement
Adjustment
Negotiations/Consultations
Negotiations
5
LHIN/Sector Responsibilities
LHINs are responsible for:
•
•
•
Training and supporting HSPs through the Community Annual Planning
Submission (CAPS) and M-SAA processes
Negotiating performance targets within the context of a provincial framework
Monitoring the achievement of specific performance goals under the M-SAA
and ongoing performance management
HSPs are responsible for:
•
•
•
•
Ensuring their governance and operations support high quality care
Promoting leading performance improvement approaches
Providing access to high quality health services and coordinated health care
in an effective and efficient manner
Identifying integration opportunities and engaging the public and
stakeholders in any planned service changes
6
THE M-SAA PROCESS
7
2014-17 M-SAA Approach
•
In May 2013, the M-SAA Advisory Committee was established (Members of
the Advisory committee include LHIN staff, Ministry staff, sector representatives and
sector Association representation)
•
In July 2013 the mandate and scope of authority of the Committee was
established by the LHIN CEOs and was confirmed as follows:
 Work with LHIN Legal Services, identify opportunities to revise language
that either requires updating or would benefit from greater clarity
 Work with community sector representatives, invite and review sector
feedback (175 sector comments were received and individually addressed)
 Finalize a three year M-SAA by the end of 2013 to enable local
execution by March 31, 2014.
•
On December 17, 2013 the M-SAA Advisory Committee endorsed the
2014-17 M-SAA and Schedules
•
The Committee will continued to meet throughout the life of the agreement to
advance M-SAA related priority issues
8
M-SAA Development Principles
•
The M-SAA Advisory Committee was guided by the following principles:
 The process is to be undertaken with a spirit of trust and collaboration
among the province’s community HSPs, sector associations and the
LHINs.
 The M-SAA will align with provincial health system priorities and be
consistent with Ministry of Health and Long-Term Care (ministry) policy,
legislation and regulations.
 The M-SAA will strive to streamline processes, minimize administrative
burden and provide clarity for HSPs where possible.
9
M-SAA Committee Structure
M-SAA Advisory Committee
(see slide 7 for membership)
M-SAA Indicators
Work Group
(see Appendix 1 for membership)
M-SAA Planning and Schedules
Work Group
(see Appendix 1 for membership)
M-SAA INDICATOR SUPPORT: HEALTH SYSTEM INDICATOR INITIATIVE
M-SAA LEGAL COUNSEL SUPPORT: LHIN LEGAL SERVICES BRANCH
M-SAA SECRETARIAT SUPPORT: LHIN COLLABORATIVE
LOCAL M-SAA IMPLEMENTATION: LHIN M-SAA LEADS
*See Appendix 2 for all M-SAA Membership
10
2014-17 CAPS Approach
•
The Community Accountability Planning Submission (CAPS) is a threeyear planning document that facilitates the negotiation of the M-SAAs
between the LHIN and each HSP.
•
In the absence of definitive funding targets, CAPS will be based on a
planning assumption of 0% base adjustment. CAPS should be prepared to
maintain service levels within the 0% planning assumption
•
The M-SAA Schedules will be refreshed in the fall of each year of the
agreement to confirm the current year’s planning assumption and to update
the agreement’s performance and explanatory indicators
•
The provincial due date for the submission of a HSP Board approved CAPS
was November 15, 2013.
11
HNHB LHIN Engagement Strategy
•
Aug 30-Sept 9, 2013: HSPs from the HNHB LHIN were asked to assist in
testing of the CAPS file.
•
Sept 10-15, 2013: HSPs were asked to contribute input into new Part A of the
CAPS (Narrative) as well as feedback on past CAPS Narrative.
•
Oct 1, 2013: HNHB and Province launches CAPS educational material
including. Orientation presentation (taped), User Guide, Reference Manual.
•
Oct 1-4, 2013: HNHB HSPs were invited to submit questions to the LHIN
regarding CAPS Part A and B and on all educational material.
•
Oct 3, 2013: HNHB holds HSP Question and Answer teleconference with
LHIN Financial, Quality and Risk Management, Health System
Transformation and Access to Care staff in attendance.
12
HNHB LHIN Engagement Strategy continued.
•
Oct 4 - Oct 10, 2013: General CAPS questions were sent to HNHB LHIN lead
and response have been provided. Specific questions were directed to review
teams.
•
Oct 10, 2013: Provincial FAQ document is distributed to all HSPs throughout
the province. Approximately 38 questions were received from across all LHIN
engagement sessions between Oct 1-4, 2013.
•
The HNHB LHIN also offered each agency in our LHIN an opportunity to meet
with the LHIN staff face to face, or by telephone to discuss their CAPS prior to
submitting their CAPS on Nov 15, 2013.
13
2014-17 HNHB CAPS Reporting Compliance
Report
%
CAPS 2014-17 Submission on Time (due date November 2013)
98%
CAPS 2014-17 Complete/ accurate Data at time of submission
11%
Board Approval Received On Time (due date November 15, 2013)
77%
Submission of No Deficit
100%
Source: Internal Reporting and Monitoring
Results based on 96 CAPS Submission
14
PERFORMANCE
15
Performance Indicators
•
In April 2010, the LHIN-led Health System Indicators Initiative (HSII) was
established to create a coordinated, system-based approach to indicator
identification, development, maintenance and reporting.
•
Central to the mandate of HSII is the close collaboration with provincial and
national partners in order to leverage their organizational expertise related to
indicator development, benchmarking, data extraction, and analysis.
•
In September 2013 a revised mandate provided a greater focus on alignment
to system priorities, advancing system performance improvement through the
SAAs and other mechanisms, and enabling monitoring and reporting.
16
M-SAA Indicator Work Group Focus and Approach
•
To review current indicators and develop recommendations to reduce the
number of indicators
•
To develop recommendations regarding the definition and target setting
approach for the administrative indicator calculation
•
To align existing indicators with pan-LHIN imperatives
17
Performance Indicators (Schedule E)
The Performance Schedule E in the M-SAA contains the following two indicator sections:
1. Pan-LHIN Indicators:
Core indicators that are relevant to all LHINs and all community sector HSPs and Sector-Specific
indicators that are only relevant to a specified sector.
•
Performance Indicators are measures of HSP performance for which a Performance Target is set;
Technical specifications of specific
•
Explanatory Indicators are measures of HSP performance for which no Performance Target is set.
Technical specifications of specific.
Performance and Explanatory Indicator descriptions can be found in the “M-SAA 2014-17 Indicator
Technical Specifications” document. On the HNHB LHIN website. 2014-17 MSAA Indicator Tech Specs
2. LHIN-Specific Performance Obligations:
Each LHIN may add specific performance objectives and obligations for their HSPs. LHINs are
committed to minimizing any undue burden placed on providers with respect to performance
management by focusing on a limited number of indicators aligned with local priorities.
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Core (All Sectors) Performance Indicators
 Balanced budget - Fund type 2
 Proportion of budget spent on administration
 Variance forecast to actual expenses
 Percentage total margin
 Service activity by functional centre
 Variance of forecasted to actual units of service
 Number of individuals served
 Percentage of Alternative Level of Care (ALC) days
19
Community Care Access Centres Sector
Performance Indicators


*
Access: Wait time 1. From Hospital Discharge to Service Initiation (Hospital
Clients)
Access: 90th Wait time 2. 90th percentile Wait time from Community Setting to
Community Home Care Services
Percentage people registered with Health Care Connect who are referred
(Retired)
Details:
– Reporting obligations are already in place with the ministry
20
Community Support Services Sector
Performance Indicator
•
There are no Performance Indicators for 2014-15 in the M-SAA for the
Community Support Services sector.
21
Community Health Centres Sector
Performance Indicators








*
Cervical cancer screening
Colorectal Screening rate
Inter-professional diabetes care rate
Influenza vaccination rate
Breast cancer screening rate
Periodic health exam
Vacancy Rate (for NPs and Physicians)
Access to primary care clinical service (New)
Individuals served by functional centre (Retired)
Details:
– Already a Core indicator
The HNHB LHIN staff are engaging the Community Health Centres (CHCs) until
January 15, 2014 to negotiate targets for these eight CHC specific indicators.
22
Community Mental Health and Addiction Sector
Performance Indicators
•
There are no Performance Indicators for the Mental Health and Addiction
sector in 2014-15.
23
HNHB LHIN-Specific
Performance Indicators and Reporting Obligations
Community Support Services (CSS) and Community Mental Health and
Addiction (CMH&A):
Quality Obligation:
•
“CSS and CMH&A organizations will work with the HNHB LHIN to develop
and have in place the following three components of the quality plan:
1) Board approved policy on quality; 2) Balanced scorecard; and,
3) A Quality Plan to track variances and outline strategies for improvement.
The CSS and CMH&A will align quality strategies with the LHIN-wide Quality
Plan as set out by the Quality Guidance Council. This will be submitted to the
HNHB LHIN at the end of each fiscal year (2014-15, 2015-16 and 2016-17)”
24
HNHB LHIN-Specific
Performance Indicators and Reporting Obligations
Community Health Centres and CCAC:
Quality Obligation:
•
“The [CHC/CCAC ] will work to develop a Quality Improvement Plan (QIP)
with guidance from the Health Quality Ontario (HQO) quality framework and
templates for submission by the [CHC/CCAC] to HQO on or before fiscal
year end. The QIP will inform HQO’s review and feedback of the broader
[CHC/CCAC] sector alignment with its quality framework. The [CHC/CCAC ]
will also align its quality strategies with the LHIN-wide Quality Plan set out by
the Quality Guidance Council and provide the HNHB LHIN with a copy of
their QIP to HQO”
•
% of clients registered with CHC diagnosed with diabetes who have had a
foot exam within the last 12 months
25
HNHB LHIN-Specific
Performance Indicators and Reporting Obligations
All Providers:
Behavioral Supports Ontario (BSO) Obligation:
•
LHIN providers were identified in 2013-14 as either an Integrated
Community Lead (ICL) agency or a Participating BSO ICL Contributing
agency.
•
All agencies are expected to continue their roles in 2014-15.
•
Each agency should refer to the HNHB LHIN’s website for information on the
responsibilities of their agency.
BSO HNHB LHIN Site
26
Performance Standards
•
All performance indicators have an associated target and standard of
performance. Variance outside of the standard triggers a performance
management processes.
To complete the targets and standards for the performance indicators, the
following principles will be employed:
• Where provincial targets and corridors exist, the LHINs and HSPs will
take these into consideration.
• Where appropriate, use past experience from M-SAA and MLPA
indicators.
• Incorporate analyses of historical variation to inform corridor
recommendations.
• Use % range for financial and volume indicators.
27
Proportion of Budget Spent on Administration
•
The Proportion of Budget Spent on Administration indicator measures how much an
organization spends on administrative services relative to total operating expenditures.
•
The HNHB LHIN’s expectation is that a shifting of resources away from administration will:
•
•
increase capacity to deliver services directly impacting client care
contribute to the sustainability of the local health system.
In 2013-14 the HNHB LHIN asked each HSP to review their functional center allocations and
provided education to the HSP’s on how to calculate this indicator.
The LHIN has completed its CAPS review of the change in this indicator target from 2013-14
to 2014-15
Next steps include further engagement with HSP’s to determine the reasons why some HSPs
still have high targets.
28
Performance Management
•
How the LHIN chooses to deal with an indicator outside the standard
depends on a number of factors, including:
What is the realized and/or potential impact on the clients served?
Is this the first blip on an otherwise clean performance record?
Is this a unique event and unlikely to recur?
Are other areas of the organization or other HSPs affected?
What is the LHIN’s confidence in the HSP’s ability to manage
performance going ahead?
Depending on the above, the LHIN could choose to start with a less formal
tact. The formal process is always available...and can be triggered at any
point.
•
•
•
•
•
•
29
NEXT STEPS
30
Next Steps and Important Dates
The LHINs will work collaboratively with their HSPs to implement M-SAAs by
March 31, 2014
HSP Education Session…………………………………………….January 15, 2014
Local Indicator target setting engagement…...Dec. 16, 2013 to January 15, 2014
M-SAAs sent to 96 HSPs………………………………………….January 31, 2014
96 HSPs signed M-SAAs returned to HNHB LHIN…………………March 1, 2014
2014-17 M-SAAs take affect………………………………………….…April 1, 2014
31
A copy of this slide deck will be available on the HNHB LHIN
website at the following location:
2014-17 M-SAA HNHB Presentation
Questions may be sent to the HNHB LHIN
until January 31, 2014 to:
hnhblhin.caps@lhins.on.ca
32
APPENDICES
33
Appendix 1:
Summary of Key Changes between current and new M-SAA
34
Appendix 1:
Summary of Key Changes continued
35
Appendix 1:
Summary of Key Changes continued
36
Appendix 2:
M-SAA Advisory Committee Membership
37
Appendix 2:
M-SAA Advisory Committee Membership continued
38
Appendix 2:
M-SAA Planning and Schedules Work Group Membership
39
Appendix 2:
M-SAA Planning and Schedules Work Group Membership
continued
40
Appendix 2:
M-SAA Indicators Work Group Membership
41
Appendix 2:
M-SAA Indicators Work Group Membership continued
42
Appendix 2:
M-SAA Indicators Work Group Membership continued
43
Appendix 3:
Core (All Sectors) Explanatory Indicators
 Cost per individual serviced by program/service/functional centre
 Cost per unit of service by functional centre
 Client experience (New Category)
Details:
– Client Experience was an explanatory indicator for the
Mental Health and Addiction sector only in 2013-14
– Indicators Work Group identified need to enhance
linkage with quality and patient experience for all sectors
44
Appendix 3:
Community Care Access Centres Explanatory Indicators



Access: Wait time 1. From hospital discharge to service initiation (hospital
clients) by population groups (short stay, short stay rehab, long-stay
complex)
Access: Wait time 2. 90th percentile wait time from Community setting to
community home care services by population groups (short stay acute, short
stay rehab, long-stay complex)
Average monthly cost per episode (adult short stay, adult long-stay complex,
end of life, children medically fragile)
45
Appendix 3:
Community Care Access Centres
New Explanatory Indicators


Clients with MAPLe scores high and very high living in the community
supported by CCAC
Clients placed in LTCH with MAPLe scores high and very high as a
proportion of total clients placed
Details:
– Moved from CCAC performance indicator category
– Indicators fit this category and provide valuable information about
how the system is functioning and the opportunities for change
– Indicators are not a good measure for performance as targets are set
locally by each LHIN
46
Appendix 3:
Community Care Access Centres Developmental Indicators
*
*
*
Percentage of clients with a new or existing pressure ulcer that failed to
improve (Retired)
Medication safety (Retired)
Percentage of home care clients who say they have fallen in the last 90 days
(Retired)
Details
– Indicators retired as developmental
– Indicators were not identified by HQO on the Common Quality
Agenda
47
Appendix 3:
Community Support Services Explanatory Indicator
 Number of persons waiting for service (by functional centre)
48
Appendix 3:
Community Support Services Developmental Indicators

*
*
Average number of days waited for first service (by functional centre) (New
Category)
Details:
– Moved from CSS Explanatory indicator category as the data is not
yet available
– Move to explanatory in years 2 or 3
Repeat unscheduled emergency visits within 30 days for mental health
conditions (Retired)
Repeat unscheduled emergency visits within 30 days for substance abuse
conditions (Retired)
Details:
– Indicators are difficult to measure as cannot follow clients between
the hospital and the community
49
Appendix 3:
Community Health Centres Explanatory Indicators








Emergency visits best managed elsewhere (New)
Client satisfaction – Access (New)
Clinical support staff per primary care provider (New)
Cultural interpretation (New)
Exam rooms per primary care provider (New)
New grads/new staff (New)
Number of new patients (New)
Non-Primary Care activities (New)
50
Appendix 3:
Community Health Centres Explanatory Indicators
continued





*
*
Number of registered clients (New)
Specialized care (New)
Supervision of students (New)
Third next available appointment (New)
Non-insured clients (New)
Repeat unscheduled emergency visits within 30 days for mental health
conditions (Retired)
Repeat unscheduled emergency visits within 30 days for substance abuse
conditions (Retired)
Details:
– Data is a challenge as the cell size is small
51
Appendix 3:
Community Health Centres Developmental Indicator

CHC clients hospitalized for Ambulatory Care sensitive conditions
52
Appendix 3:
Community Mental Health and Addiction
Explanatory Indicators
 Number of days waited from referral/application to initial assessment
complete
 Average number of days waited from initial assessment complete to service
initiation
 Repeat unscheduled emergency visits within 30 days for mental health
conditions (New Category)
 Repeat unscheduled emergency visits within 30 days for substance abuse
conditions (New Category)
Details: both of the 2 indicators above were moved to Explanatory
indicator in 2014-15
* Client experience (Retired)
Details: Moved to Core indicator
53
Appendix 3:
Community Mental Health & Addiction. Developmental
Indicator

OCAN/GAIN Indicator
54
Appendix 4:
M-SAA Content - Articles
Article 1 Definitions and Interpretation
Clarifies terminology used throughout the document.
Article 2 Term and Nature of the Agreement
Defines the term of the service accountability agreement as April 1, 2014 to March 31, 2017.
Article 3 Provision of Services
Describes how services will be provided in accordance with legislation, applicable policies,
e-health/IT compliance and the terms of this agreement. Discusses subcontracting services
and conflict of interest.
Article 4 Funding
Outlines conditions of funding, payment and provision limitations. Procurement and
disposition of goods and services are also described.
Article 5 Repayment and Recovery of Funding
Defines circumstances under which funding may be adjusted and/or recovered.
55
Appendix 4: M-SAA Content - Articles continued
Article 6 Planning and Integration
Discusses multi-year planning CAPS requirements in alignment with LHIN IHSP and priorities.
Article 7 Performance
Discusses the need for ongoing performance improvement and the mitigating process in the event
of performance factors (non-performance).
Article 8 Reporting, Accounting and Review
Describes the obligations of reporting and record maintenance, French language requirements,
disclosure of information, transparency and reviews.
Article 9 Acknowledgement of LHIN Support
HSP publications are required to note LHIN support, be approved by the LHIN, and indicate views
do not necessarily reflect those of the LHIN or Government.
Article 10 Representations, Warranties and Covenants
Confirms the HSP’s ability to enter into the agreement and carry out the funded services with the
appropriate governance, personnel and documentation.
56
Appendix 4:
M-SAA Content - Articles continued
Article 11 Limitation of Liability, Indemnity and Insurance
Outlines the limitation of liability and indemnification for the LHINs and the required insurance
provisions for the HSP.
Article 12 Termination of Agreement
Describes the parameters for termination of the agreement by the LHIN and by the HSP.
Article 13 Notice
Details how notices to a party must be provided.
Article 14 Additional Provisions
Identifies additional provisions to the agreement.
Article 15 Entire Agreement
Defines the agreement as constituting the entire agreement, superseding all prior agreements.
57
Appendix 5:
M-SAA Content - Schedules
58