2014-17 Multi-Sector Service
Accountability Agreement (M-SAA)
An Overview
Presentation to Health Service Providers
January 10, 2014
2014-17 M-SAA
An Overview
 Development and Preparation of the M-SAA
 Template Agreement Components
 Schedules
 Indicators
 Next Steps
 Questions
2
What is an M-SAA?
Core lever for HSP accountability and performance management
• A tool to bring all the various contractual agreements between
community HSPs and the LHINs into one document
• Required under LHSIA and Ministry-LHIN Performance
Agreement (MLPA)
• A vehicle to delineate accountabilities and performance
expectations
• A mechanism to clarify that the HSP will be responsible for
performance as well as planning and integration towards the
development of a health system
3
Pan-LHIN Development, Local Execution
Developing provincial templates for local execution
• Consistent template agreement for all community sector
HSPs developed through comprehensive consultation with
HSP associations and member representatives (membership
listed in Appendix 1)
• Schedules for each subsector (CCAC, CHC, MH&A
and CSS) developed through
consultation with sub-sectors
• Individual LHINs negotiate
performance indicator
targets with each HSP in
alignment with pan-LHIN
guidelines
4
M-SAA Development Principles
Enabling close ongoing collaboration with the Community Sector
•
The M-SAA Advisory Committee is co-chaired by Louise Paquette and
Scott McLeod and brings together senior executives from M-SAA sector
associations, community HSPs and the LHINs to provide a central forum for
enabling dialogue on provincial M-SAA issues
•
The Committee is guided by the following principles:
•
•
The process is 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 MOHLTC policy, legislation and regulations.
•
The M-SAA will strive to streamline processes, minimize administrative
burden and provide clarity for HSPs where possible.
Committee membership is shown below
5
M-SAA Structure
Comprehensive Consultation through Multiple Tables
M-SAA Advisory Committee
M-SAA Indicators
Work Group
M-SAA Planning & Schedules
Work Group
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
6
M-SAA Advisory Committee Membership
Sector
Organization
Individual, Title
LHIN
NE LHIN
Louise Paquette, CEO
LHIN
CW LHIN
Scott McLeod, CEO
LHIN
NE LHIN
Kate Fyfe, Senior Director
LHIN
CW LHIN
Brock Hovey, Senior Director
LHIN
CW LHIN
Neil McIntosh, Director
CHC
AOHC
Adrianna Tetley, Executive Director
CHC
Davenport Perth
Neighbourhood CHC
Kim Fraser, Executive Director
CSS
OCSA
David Hughes, Director, Membership Development
CSS
CANES Community Care
Gord Gunning, CEO
7
M-SAA Advisory Committee Membership continued
Sector
Organization
Individual, Title
CMH&A
Addictions & Mental Health
Ontario
David Kelly, Executive Director
CMH&A
CMHA Ontario
Camille Quenneville, CEO
CMH&A
CMHA Toronto
Steve Lurie, Executive Director
CCAC
OACCAC
Sharon Baker, COO
CCAC
CE CCAC
Don Ford, CEO
LTC
OANHSS
Jeff Graham, Director, Public Policy
LTC
City of Toronto
Reg Paul, General Manager, LTC Homes & Services
LTC
OLTCA
Paula Neves, Director of Health Planning and Research
LTC
Extendicare Inc.
Christina McKey, VP, Eastern Operations
8
LHIN/Sector Responsibilities
Advisory Committee and Work Group Mandates
M-SAA Advisory Committee

Established to provide advice to the LHIN CEOs and support for the completion of the
2014-17 M-SAA template agreement and schedules in alignment with provincial
strategic directions.
M-SAA Indicators Work Group

Established to support the M-SAA Advisory Committee. Based on direction from the
LHIN CEOs, the Work Group is responsible for producing a series of documents and
recommendations including a list of recommended M-SAA indicators, technical
specifications, target setting guidelines and education materials.
M-SAA Planning & Schedules Work Group

Established to support the M-SAA Advisory Committee. Based on direction from the
LHIN CEOs, the Work Group is responsible for producing a series of documents and
tools including M-SAA Schedules, CAPS forms and planning submission guide and
educational documents.
9
LHIN/HSP Accountability Relationship
How do the various CAPS/M-SAA components fit together?
Community
Accountability
Planning Submission
(CAPS)
Planning

Multi-sector Service
Accountability
Agreement
(M-SAA)
Commitment
Negotiations/Consultations

Quarterly Reports
[Ontario Healthcare
Report Standards (MIS)]
Measurement

Remediation
Negotiation,
Implementation of
Consequences
Adjustment
Negotiations
10
LHIN/Sector Responsibilities
What are the responsibilities of the LHINs and the HSPs?
LHINs are responsible for:
•
Training and supporting HSPs through the 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 governance and operations that 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.
11
Process for Finalizing New M-SAA
At a high level, how was the M-SAA developed and finalized?

LHINs revised language in the 2011-14 M-SAA that required updating or would
benefit from greater clarity as a draft 2014-17 M-SAA for sector feedback.

Three 3-hour M-SAA Advisory Committee meetings to review and discuss
comments and suggestions on draft 2014-17 M-SAA.

175 sector comments received and individually addressed.

Committee endorsed 2014-17 M-SAA and Schedules on December 17, 2013.

Pan-LHIN commitment to reduce, align and enhance consistency of local
indicators.

Committee will continued to meet throughout the life of the agreement to advance
M-SAA related priority issues.
12
M-SAA Content – Articles
Article 1 Definitions & 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, ehealth/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
13
M-SAA Content - Articles continued
Article 6 Planning & 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.
14
M-SAA Content - Articles continued
Article 11 Limitation of Liability, Indemnity & 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.
15
M-SAA Content - Schedules
Schedule
Title
Description
A
Description of Services
Describes the services delivered by the HSP, client
populations and geography served
B
Service Plan
Describes the financial and statistical status of the HSP
C
Reports
Identifies, describes and sets due dates for HSP reporting
D
Directives, Guidelines, Policies
Identifies applicable MOHLTC policies
E
Performance
Identifies indicators, standards and local performance
requirements
F
Template for Project Funding
Template used for funding special projects
G
Declaration of Compliance
Form to be completed by the HSPs Board of Directors to
declare that the HSP has complied with the terms of the
Agreement
16
Summary of Main Changes - Schedules
What are the key changes between current and new Schedules?
SCHEDULE
DIFFERENCE
Schedule A
• None
Schedule B
• Schedule B1 - Added row 2 (HBAM) and row 3
(QBP) planning targets along with their functional
centres for use by CCAC’s
Schedule C
• Revised dates revised to reflect appropriate
reporting period.
• Updated to reflect that Supplementary Reporting
(including AAH) - Quarterly Report and Annual
Reconciliation Report (ARR) will be reported
through SRI
COMMENTS
• Self Reporting Initiative (SRI) has
replaced the Web Enabled Reporting
System (WERS) for reporting
17
Summary of Main Changes (continued)
What are the key changes between current and new Schedules?
SCHEDULE
DIFFERENCE
Schedule D
• Updated to reflect current directives, guidelines
and policies
Schedule E
COMMENTS
• Added Guideline for Community Health Service
Providers Audits and Reviews, August 2012
• Intended to LHINs in undertaking a
transparent process in identifying and
responding effectively and consistently
to HSPs
• Added note indicating that the Community
Financial policy is currently under review
• Review process includes MOHLTC,
LHINS and community sector
representatives
• See update from Indicators Work Group
18
Summary of Main Changes (continued)
What are the key changes between current and new Schedules?
SCHEDULE
DIFFERENCE
Schedule F
• Updated to reflect HSP “services” rather than
“deliverables”
• Added Appendix 1 - Exceptions
Schedule G
COMMENTS
19
2014 – 17 M-SAA Indicators
20
Introducing the Indicators
 Health System Indicator Initiative (HSII)
 Schedule E Indicators
 Performance Standards
 Targets Setting
 Indicator Work Group Focus and Approach
 Summary of Indicators & Technical Specifications
– Core Indicators
– Community Health Centres (CHC) Indicators
– Community Care Access Centres (CCAC) Indicators
– Community Service Sector (CSS) Indicators
– Mental Health & Addiction (MH&A) Indicators
21
Performance Indicators
Health System Indicators Initiative (HSII)
•
In April 2010, the LHIN-led 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.
•
The revised mandate introduced in September 2013 provides a greater
focus on alignment to system priorities, advancing system performance
improvement through the SAAs and other mechanisms, and enabling
monitoring and reporting.
22
Performance Indicators (Schedule E)
Pan-LHIN Performance Indicators and LHIN-Specific Obligations
The Performance Schedule (Schedule E) contains the following two indicator sections:
1. Pan-LHIN Indicators are developed through the M-SAA Indicators Work Group through HSII
(core indicators are relevant to all LHINs and all community sector HSPs; sector-specific
indicators 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 Performance Indicators can be found
in the “M-SAA 2014-17 Indicator Technical Specifications” document.
•
Explanatory Indicators are measures of HSP performance for which no Performance
Target is set. Technical specifications of specific Explanatory Indicators can be found
in the “M-SAA 2014-17 Indicator Technical Specifications” document.
2. LHIN-Specific Performance Obligations: A section where each LHIN adds specific
performance objectives and obligations for their HSPs is included. LHINs are committed to
minimizing any undue burden placed on providers with respect to performance management by
focusing on a limited number of outcome indicators aligned with local priorities.
23
Performance Indicators
Why Performance Standards?
• All performance indicators have an associated target and standard
of performance. Variance outside of the standard triggers the
performance management processes in Article 7 of the M-SAA.
• The LHIN or the HSP can identify a Performance Factor that
“…could or will significantly affect a party’s ability to fulfill its
obligations under the Agreement.”
• The identification of a Performance Factor is made formally, in
writing, to the other party and will include a description of the
Factor’s actual or anticipated impact and a description of any action
the party is undertaking, or plans to undertake, to remedy or mitigate
the Performance Factor.
24
Performance Indicators Continued
How are Indicator Targets and Corridors Determined?
•
Following the submission of the CAPS, LHINs and HSPs discuss indicator
targets that are appropriate to each organization and its local circumstances.
Targets are expected to reflect performance and drive continuous improvement.
•
To complete the targets and corridors 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
25
Performance Management
How are Performance Factors Addressed?

How a LHIN chooses to deal with an indicator outside the corridor 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 LHINs confidence in the HSPs 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.
26
Indicator Work Group Focus & Approach
 Review current indicators and develop recommendations
to reduce the number of indicators
 Develop recommendations regarding the definition and
target setting approach for the administrative indicator
calculation
 Align existing indicators with pan-LHIN imperatives
27
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
28
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:
– Moved from being only an explanatory indicator
for the Mental Health and Addiction sector
– Indicators Work Group identified need to
enhance linkage with quality and patient
experience for all sectors
29
Community Care Access Centres
Performance Indicators
 Access 1: 90th Percentile Wait Time From Hospital
Discharge to Service Initiation (Hospital Clients)
 Access 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
30
Community Care Access Centres
Explanatory Indicators
 Access: Wait time 1. 90th Percentile wait time 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)
 Clients with MAPLe scores high and very high living in the
community supported by CCAC (New Category)
 Clients placed in LTCH with MAPLe scores high and very
high as a proportion of total clients placed (New Category)
31
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
32
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 as on the
Common Quality Agenda
33
Community Support Services
Explanatory Indicator
 Number of persons waiting for service (by functional
centre)
34
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 - cannot follow
clients between the hospital and the community
35
Community Health Centres
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
36
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)
37
Community Health Centres
Explanatory Indicators Cont’d





*
*
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
38
Community Health Centres
Developmental Indicator
 CHC clients hospitalized for Ambulatory Care sensitive
conditions
39
Community Mental Health & 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: Moved to Explanatory indicator
* Client experience (Retired)
Details: Moved to Core indicator

40
Community Mental Health & Addiction
Developmental Indicator
 OCAN/GAIN Indicator
41
Next Steps
What are the work streams and key dates?
The LHINs are working collaboratively with their HSPs to finalize M-SAAs by
March 31, 2014.
CAPS Submitted to the LHIN
No v 15
75%
CAPS Reviewed and Adopted by the LHIN
complete
Jan 10
Local M-SAA Orientation for HSPs
Jan 22
CW LHIN Board to Approve M-SAA Template
Jan 14 - 28
CW LHIN to prepare M-SAA Schedules
Jan 28
LHIN to meet with HSP's to negotiate performance
expectations
Feb 14
Feb 15–28
LHINs to Prepare M-SAAs
Mar 5
LHIN to distribute Final M-SAAs to HSPs
Mar 31
HSP Board Approval of M-SAAs
Mar 31
LHIN Board Approval of M-SAAs (by Mar 31)
April 10
Post M-SAAs to Websites
Nov
Dec
Jan
Feb
Mar
Apr
42
Questions?
Comments?
43
APPENDIX 1: M-SAA Planning & Schedules
Work Group Membership
Sector
Organization
Individual, Title
LHIN
CW LHIN
Brock Hovey, Senior Director, Health System Performance
LHIN
CW LHIN
Neil McIntosh, Director, Performance and Accountability
LHIN
CH LHIN
Patrick Manhire, Senior Accountability Specialist
LHIN
HNHB LHIN
Jim Borysko, Advisor ,Health System Performance
LHIN
NE LHIN
Kate Fyfe, Senior Director
LHIN
SE LHIN
Mike McClelland, Senior Financial Analyst
LHIN
MH LHIH
Shehnaz Fakim, Senior Lead, Health System Performance
Management
44
APPENDIX 1: M-SAA Planning & Schedules
Work Group Membership continued
Sector
Organization
Individual, Title
LTC
OLTCA
Paula Neves, Director of Health Planning and Research
LTC
OANHSS
Jeffrey Graham, Director, Public Policy
CCAC
SE CCAC
Carol Ravnaas, Sr. Director Strategic Partnerships &
Accountability
CSS
Ontario March of Dimes
Jason Lye, Associate Director
CHC
Brock CHC
Ron Ballantyne, Executive Director
Riverside Community
Counseling Services
Jon Thompson, Director
MOHLTC
MOHLTC
Vanita Bhandari, Manager, Data Standards Unit , Health Data
Branch
MOHLTC
MOHLTC
Christine Brown, Team Lead, Planning & Negotiations, LLB
CMHA
45
APPENDIX 1: M-SAA Indicators
Work Group Membership
Sector
Organization
Individual, Title
LHIN
NE LHIN
Kate Fyfe, Senior Director
LHIN
NW LHIN
James Anderson, Performance and Contract Management
Consultant
LHIN
MH LHIN
Heather Kundapur, Senior Lead, Health System Performance
LHIN
TC LHIN
Greg Stevens, Senior Consultant, Performance Management
LHIN
NWLHIN
Kevin Holder, Senior Consultant, Funding & Performance
LHIN
ESC LHIN
Pete Crvenkovski, Director, Performance Quality and
Knowledge Management
LHIN
HNHB LHIN
Philip Christoff, Director, Quality & Risk Management
LHIN
HNHB LHIN
Rosalind Tarrant, Director, Access to Care
46
APPENDIX 1: M-SAA Indicators
Work Group Membership continued
Sector
Organization
Individual, Title
LHIN
HNHB LHIN
Gaya Amirthavasar, Health Information Advisor
LHIN
WW LHIN
Ted Alexander, Manager, Contracts and Accountability
CSS
Cheshire London
Angela McMillan, Attendant Services Manager
CSS
Ontario March of Dimes
Lee Harding, Director, Independent Living Services
CSS
Dale Brain Injury Services
Sue Hillis, Executive Director
CCAC
TC CCAC
Anne Wojtak, Senior Director, Performance Management &
Accountability
CCAC
OACCAC
Rod Millard, Director, Information Management
CMHA
Reconnect Mental Health
Services
Mohamed Badsha, COO
47
APPENDIX 1: M-SAA Indicators
Work Group Membership continued
Sector
Organization
Individual, Title
CHC
AOHC
Jennifer Rayner, Regional Decision Support Specialist
LTC
OLTCA
Paula Neves, Director of Health Planning and Research
LTC
OANHSS
Dan Buchanan, Director of Financial Policy
MOHLTC
MOHLTC
Naomi Kasman, Senior Health Analyst, Health Analytics Branch
MOHLTC
MOHLTC
Soma Mondal, Manager , Health Analytics Branch
48