MULTISECTOR SERVICE ACCOUNTABILITY AGREEMENTS MSAA 2019 20 CAPS

MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENTS (MSAA) 2019 -20 CAPS, Schedules and Indicators Education Session October 16 th, 2018 Toronto Central LHIN HSP Education Webinar

Agenda 1. Multi-Sector Service Accountability Agreements (MSAA) 3 2. MSAA Governance Structure 6 3. Toronto Central LHIN’s Performance Management Framework 8 4. Planning for 2019 -20’s MSAA 11 • Changes to the 2018 -19 CAPS • 13 Additional Resources & Education for the CAPS Refresh • 15 Important* Considerations when Completing CAPS Refresh 16 5. CAPS & MSAA Schedules Timelines 17 2

1. The Multi-Sector Service Accountability Agreement 3

XXX HSP • Articles set out the terms and conditions to enable the provision of services to the local health system by HSPs • Some key articles include: • Provision of services (e. g. HSPs cannot limit services by geography, HSPs are required to notify LHINs where services are being reduced, started, expanded, etc) • Repayment & Recovery of Funding (LHIN can reconcile unspent funding, forecasted surpluses, etc) • Performance (Right to request performance meetings and develop Performance Improvement Plans with HSPs, etc) • Provincially negotiated between the 14 LHINs and selected stakeholders (e. g. HSP Leadership, AMHO, CMHA) 4

XXX HSP • Schedules include: • Submission of HSP Supplemental (replaced Schedule A) • LHIN funding (Schedule B) • Reporting deadlines (Schedule C) including: • SRI/Quarterly Reports • Audited Financial Statements • Annual Reconciliation Reports • French Language Services Report • Declaration of Compliance • Directives, Policies, Guidelines applicable to HSP sector (Schedule D) • Clinical/Service Volumes, Performance Indicators and Local Obligations (Schedule E) 5

2. MSAA Governance Structure 6

MSAA Governance Structure Comprehensive Consultation through Multiple Tables MSAA Advisory Committee MSAA Indicators Work Group (Determines Indicators to be included in MSAA) MSAA Planning & Schedules Work Group SRI Reporting Forms Work Group (CAPS templates) MSAA Legal Counsel Support: LHIN Legal Services Branch MSAA Secretariat Support: Health Shared Services Ontario Local MSAA Implementation: MSAA LHIN Leads 7

3. Toronto Central LHIN Performance Management Framework 8

Toronto Central LHIN Performance Management Framework • Toronto Central LHIN currently measures and evaluates HSP performance through several performance and reporting domains: • • Service activity and volumes, including key performance targets Financial health Local obligations (which may reflect activity or volume requirements) Adherence to Schedule C reporting requirements (including both timeliness and accuracy) • Each of the four domains above are considered and each organization’s performance is assessed using a four-level Performance Management Framework (slide 8). • In evaluating performance, we use a combination of quantifiable reported data through SRI reporting and LHIN-led reporting initiatives, and qualitative information collected in consultation with the performance management leads. 9 • As such, timeliness and accuracy of CAPS and Quarterly reports is

Performance Management Framework Leve Assessment Description l Minor to no concerns in both the performance and reporting 1 domains, and Met or exceeded 75% or more of key performance indicators Isolated or one-time concerns in one or two performance domains, and/or 2 Isolated or one-time concerns identified in reporting domain, and/or Met 51 - 74% of performance indicators Repeated or concurrent concerns in one or two performance domains, and/or Isolated or one-time concerns in multiple performance domains, 3 and/or Repeated concerns identified in reporting domain, and/or Met 25 - 50% of performance indicators Ongoing, unaddressed concerns in multiple performance domains, 10 and/or 4

4. Planning for 2019 -20’s MSAA 11

Planning for 2019 -20’s MSAA • The MSAA Advisory Committee is working toward a new three year agreement effective from April 1, 2019 to March 31, 2022. • To support this new agreement the MSAA indicators and schedules have been refreshed and updated: • • A (Description of Services) B (Service Plan) C (Reports) D (Directive Guidelines and Policies) E (Performance) (MSAA Indicator Work Group) F (Project Funding Template) G (Compliance) *Note that final approval from the CEO Council is upcoming, so changes may occur 12

CAPS Changes for 2019 -20 • Removed 4 Functional Centres that changed to Account Headers effective April 1, 2018 • • • 72 5 10 40 COM Clinics/Programs - Therapy Clinic Removed 72 5 10 50 COM Clinics/Programs – Chronic Disease Clinic 72 5 50 45 COM Health Prom/Educ. & Com Dev- Personal Health and Wellness 72 5 50 35 COM Health Prom/Educ. & Com Dev - COM Chronic Disease Education, Awareness and Prevention Added 6 Functional Centres (2 New, 4 Previously reported in one of the F/C’s above that became Account Headers in April 2018) • New • 72 5 10 50 50 Clinics/Programs - Chronic Disease – Cardiac Rehabilitation Clinic • 72 5 50 45 05 Personal Health and Wellness – General • • Existing in OHRS (New to CAPS reporting) • 72 5 50 45 10 Personal Health and Wellness – Mental Wellness, Personal Health Practices and Coping Skills • 72 5 50 45 20 Personal Health and Wellness – Oral Health • 72 5 50 45 30 Personal Health and Wellness – Healthy Child • 72 5 50 45 40 Personal Health and Wellness – Youth Development 13 Confirmed that Community Paramedicine (72 5 30 80 05) has been added to

CAPS Changes for 2019 -20 • Edit Checks Added • • • Financial and Service Activity reporting Pages • • On the Service Selection Screen when a Functional Centre is selected it must have a corresponding TPBE selected to identify the program funding that the service applies to. If a provider does not select a functional centre on the Service Selection screen but completes planned amounts on the Act_Summary screen for that functional centre, an error will be flagged. Added columns for Budget for 2020 -21 and 2021 -22. • These columns are not locked but do populate from the input into the Budget 2019 -20 column E Variance calculations have been added for each line to highlight changes between the 201819 CAPS budget (original) and the 2019 -20 CAPS budget (proposed). The HSP specific view on the Activity Page now has two options: • Show the HSP specific Functional Centres that they have selected along with the “Mandatory” services • Show the HSP specific Functional Centres that they have selected along with all of the service lines. This option is available where changes to the Mandatory lines have occurred after the report was finalized. Main Menu • Added a calculation in Column F that flags any Changes to the budget from 2018 -19 CAPS 14 • The “Verify Edit Checks” link will show an û to the left of the link when there any

Additional Resources & Education for the CAPS Refresh HSPs should first utilize the below resources when completing the 2019 -2020 CAPS, and if they still require support, please reach out to Accountability. Planning@tc. lhins. on. ca or your Performance Lead (slide 48. ) • 2018 -19 CAPS Completion Guide and CAPS Guidelines contain important information to assist HSPs in completing the CAPS process. • Detailed step by step training is available in the CAPS completion guide and through the recorded webinar at: https: //ali. health. gov. on. ca/p 9 eiv 0 i 80 rc/ • All resources related to CAPS will be uploaded by EOD 19 th Oct, to Toronto Central LHIN’s website at http: //www. torontocentrallhin. on. ca/forhsps/accountabilityagreements/msaa/caps. aspx • All data standards inquiries for all sectors should be directed to HDBDS@ontario. ca. For directions on how to direct inquiries, please access the PDF embedded here 15

Important Considerations for 2019 -20 CAPS & MSAA • CAPS and Q 2: Identified Issues • There have been some identified CAPS/Q 2 template issues • More details including workarounds are outlined in the FAQ document here • Updated contact for hospital MSAAs/CAPS- Luciano. Veta@tc. lhins. on. ca • Community Rate Harmonization • • One-time funding volumes are *not* to be included in CAPS • • • Goal: To establish consistent service definitions and units of measure for Functional Centres (FC) Multi-year initiative starting this fiscal, focusing on a sub-set of FCs HSPs delivering the services associated with these FCs will be engaged in advance and during CAPS negotiations Reported through Toronto Central LHIN Funding Management Tool (FMT) www. tclhin. ca For questions or issues related to using FMT, contact TCLHIN. Reporting@lhins. on. ca Community Health Centres: Supplemental Indicators • Starting 2019 -20, Toronto Central LHIN is requesting that all CHCs begin reporting on noninsured clients • Revision of Local Obligations for 2019 -20 • Data errors 16

5. CAPS & MSAA Timelines 17

CAPS & MSAA Timelines • HSPs received a communication on October 10 th with key timelines for planning submissions • Timelines are also available on our website at: http: //www. torontocentrallhin. on. ca/forhsps/accountabilityagreements. aspx Community Hospitals* Long-Term Care Activity Toronto Central LHIN will conduct local CAPS, HAPS and LAPS (Planning Submissions) Schedules and Indicators Education webinar for HSPs. Planning Submissions (CAPS/HAPS) open in the Self Reporting Initiative (SRI) and (LAPS) on the Long-Term Care Home Portal at https: //hsimi. ca/LTCHome HSPs can start to complete their submissions. Formal 60 Day LHSIA Notices Issued to HSPs stating SAAs are being negotiated. Draft CAPS and HAPS must be submitted to SRI and, draft LAPS on the Long-Term Care Home Portal at https: //hsimi. ca/LTCHome for Toronto Central LHIN review. Engagement with HSPs on submissions, local obligations, 2018/19 risks, opportunities and negotiations for 19/20 (face to face or phone). Final date for completion of LHIN negotiations with HSPs to review Planning Submissions and negotiate proposed H-M-L-SAA targets and content for schedules. Approved CAPS/HAPS submitted to SRI and LAPS to the Long-Term Care Home Portal at https: //hsimi. ca/LTCHome for Toronto Central LHIN to create agreements. (HSPs are required to manage their own internal approval processes; as of end of business this day we will assume most recent submission has received internal approvals). Final date for H-M-L-SAA documents and Schedules to be sent to HSPs from LHIN. Final date for execution of signed H-M-L-SAAs. 2019/20 H-M-L-SAAs come into effect. HSPs* (MSAA) (HSAA) Homes* (LSAA) October 15 th – 19 th, 2018 October 12 th, 2018 CAPS/HAPS (and Q 2) templates are October 12 th, 2018 being revised as of October 9 th, any HSPs who have completed their submissions prior may have to use a new template. November 15 th, 2018 November 19, 2018 November 2018 -January 2019 Up to February 15, 2019 Up to February 28, 2019 March 31, 2019 April 1, 2019 18

Questions?

Appendix 1. 2019 -20 MSAA Schedules Overview 20

2019 -20 MSAA Schedules Schedul e A Title A 1. Description of Services A 2. Population & Geography Description Describes the services delivered by the HSP and the HSP’s client populations and geography served (Not applicable to Toronto Central LHIN HSPs, has been replaced by HSP Supplemental which can be found on our website at: http: //www. torontocentrallhin. on. ca/f orhsps/Supplemental. Data. Collection. aspx B B 1. Total LHIN Funding Service Plan Describes the financial and statistical status of the HSP B 2. Clinical Activity – Summary C Reports 21 Identifies and sets due dates for HSP

2019 -20 MSAA Schedules (cont’d) Schedule E Title 1. Core Indicators 2 a. Clinical Activity Detail Description Identifies indicators, standards and local performance requirements 2 b. CHC Sector Specific Indicators 2 c. CMH&A Sector Specific Indicators 2 d. CSS Sector Specific Indicators 3 a. Local Indicators & Obligations F Project Funding Agreement Template used for funding projects that are distinct from anything else; a unique project that has nothing to do with the existing services within the SAA (This template is not applicable to Toronto Central LHIN, funding requests are submitted through Health System Improvement Pre-Proposals. More info at 22 http: //www. torontocentrallhin. on. ca/forhsps/hsip. aspx

Recommended Changes to 2019 -20 MSAA Schedules cont’d Schedul e Change Rationale A • Removed and incorporated • into a separate CAPS Narrative B • B 1: Total LHIN Funding - added applicable dates for 2019 -20 B 2: Clinical Activity Summary • • Added applicable reporting dates for 2019 -20 • • Community Engagement and Integration Activities Reporting added Added applicable reporting dates for 2019 -20 • Was added to the MSAA template in 2018 -19 • Updated to reflect applicable 2019 -20 reporting periods Community Engagement and • Was added to the MSAA • C - CHC C - CMHA • • • The information captured is used for LHIN planning and not relevant to accountability Updated to reflect 2019 -20 The information is redundant as it is a summary of other information collected Updated to reflect applicable 2019 -20 reporting periods

Recommended Changes to 2019 -20 MSAA Schedules cont’d Schedul e Change C - • CMHA & CSS • C - CSS • • D - CHC • D - • CMHA & CSS Rationale Added applicable reporting dates for 2019 -20 • Updated to reflect applicable 2019 -20 reporting periods Community Engagement and Integration Activities Reporting added Added applicable reporting dates for 2019 -20 • Was added to the MSAA template in 2018 -19 • Updated to reflect applicable 2019 -20 reporting periods Community Engagement and Integration Activities Reporting added Added additional directives, polices and guidelines • Was added to the MSAA template in 2018 -19 • Relevant to sector Added additional directives, polices and guidelines • Relevant to sector 24

Recommended Changes to 2019 -20 MSAA Schedules cont’d Schedul e Change D - CMHA E • Rationale • Relevant to sector • Added additional directives, polices and guidelines See indicator slides F • No change • G • Added applicable period • Section 11 of the Public Sector Compensation Restraint to Protect Public Services Act, 2010 is still applicable Updated to reflect the applicable period Note: schedules will be “re-lettered” prior to final release 25

Appendix 2. 2019 -20 MSAA Indicators Overview 26

Indicator Work Group Focus & Approach • The work group will be completing an in-depth review of the indicators, technical specifications and target setting guidelines • It aims to deliver a slate of meaningful and measureable indicators that reflect the patients’ continuum of care, promotes patient centred discussions among all the sectors and in which each sector can recognize their contribution • Recognizing that the work will go beyond the deadlines for the usual refresh process the group has expanded its work plan and will continue its work through the remainder of the fiscal year 27

Approach to the Technical Specifications • A technical specification (tech spec) document is developed each year. The tech specifies indicator definitions, calculations, reporting periods, and other technical information • The work group will be updating the tech spec to more clearly describe and define the indicators, and will add a section that identifies the CAPS location for ease of reference 28

Approach to Indicator Targets • A target setting document is developed each year that provides performance target and corridor setting methodology to guide consistency and commonality across the LHINs and health service providers (HSPs) when establishing targets. • The performance target and corridor-setting guideline accompanies the indicator technical specification document. • Note: Performance targets and corridors are only established for performance indicators. 29

Approach to Indicators • SAA indicator categories have be updated to reflect recommendations from the Data and Performance Work Stream • As such, indicator decisions have been approached with these new categories in mind New Categories Current Categories • Performance • Explanatory • Monitoring • Developmental • Explanatory • Developmental • Future* *Note: Future Indicators would not be included in the SAA 30

SAA Indicator Categories Indicator Type Criteria Performance A measure of HSP performance for which a Performance Target is set. A performance indicator is a valid, feasible measure of HSP performance over which the HSP has control or substantial influence. Monitoring A measure of HSP performance for which no Performance Target is set. A monitoring indicator is a valid, feasible measure of HSP performance over which the HSP has control or substantial influence. Explanatory A measure that is connected to and helps to explain performance in a Performance Indicator or a Monitoring Indicator. An Explanatory may or may not be a measure of the HSP’s performance. 31 No Performance Target is set for an Explanatory

Indicator Categories cont’d Indicator Type Criteria Developmental A measure of local health system performance that requires development due to factors such as the need for methodological refinement, testing, consultation, or analysis of reliability, feasibility, and/or data quality. These indicators, once developed, are expected to be moved to either the Performance or the Monitoring category. Future A measure of local health system performance that requires development or modification of datasets or data collection processes to allow the measure to be reported. These measure may also requires work to clearly define the indicator and outline how it would be calculated. Once developed, these measures should be reviewed for placement in one of the accountability levels or for potential inclusion in the LHIN Senior Management dashboard, or for rejection. 32

Summary of Indicators • Core Indicators • • Community Health Centres (CHC) Indicators • • Performance Explanatory Developmental Community Service Sector (CSS) Indicators • • • Performance Monitoring Explanatory Developmental Community Mental Health & Addiction (CMHA) Indicators • • Explanatory Developmental 33

Core (All Sectors) Performance Indicators ü Fund type 2 balanced budget ü Proportion of budget spent on administration ü Variance forecast to actual expenditures (moved to Monitoring) ü Percentage total margin ü Service activity by functional centre ü Variance forecast to actual units of service (moved to Monitoring) 34

Core (All Sectors) Performance Indicators (cont’d) ü Number of Individuals Served (by functional centre) (name changed from Number of individuals served) ü ALC Rate (move to ‘Monitoring’) 35

Core (All Sectors) Monitoring Indicators (NEW INDICATOR CATEGORY) ü Variance forecast to actual expenditures (moved from Performance) ü Variance forecast to actual units of service (moved from Performance) ü ALC Rate (moved from Performance) 36

Core (All Sectors) Explanatory Indicators ü Cost per unit of service (by functional centre) ü Cost per individual serviced (by program/service/functional centre) ü Client experience ü Percentage of Alternative Level of Care (ALC) days 37

Community Support Services Explanatory Indicator ü Number of persons waiting for service (by functional centre) 38

Community Support Services Developmental Indicators ü Average number of days waited for first service (by functional centre) 39

Community Health Centres Performance Indicators ü Cervical cancer screening ü Colorectal Screening rate ü Inter-professional diabetes care rate ü Influenza vaccination rate ü Breast cancer screening rate ü Retention Rate (for NPs and GPs) ü Access to primary care 40

Community Health Centres Explanatory Indicators ü ü ü ü Client satisfaction – Access Clinical support staff per primary care provider Interpretation Exam rooms per primary care provider New grads/new staff Non-Primary Care activities Number of new patients Number of registered clients Specialized care Supervision of students Third next available appointment (3 NAA) Non-insured clients** (Toronto Central LHIN is requesting that all CHCs begin reporting on non-insured clients from 2019 -20) Travel time (NEW) This indicator calculates the percentage of total time GP, NP, PA, RN and RPN spend travelling for the purpose of direct service delivery to clients. High risk urban population (NEW) This indicator identifies Community Health Centres who provide services to a high risk urban population. 41

Community Health Centres Developmental Indicator ü CHC clients hospitalized for Ambulatory Care sensitive conditions (ACSC) 42

Community Mental Health & Addiction Explanatory Indicators ü Repeat unscheduled emergency visits within 30 days (for mental health conditions; for substance abuse conditions) ü Average number of days waited from referral/application to initial assessment complete ü Average number of days waited from initial assessment complete to service initiation 43

Community Mental Health & Addiction Developmental Indicator ü Ontario Common Assessment of Need (OCAN) 44

Community Mental Health & Addiction Future Indicator (NEW CATEGORY) ü Ontario Perception of Care (OPOC) Tool for MHA (NEW) 45

Reminder: Principles for Selecting Local Obligations ESSENTIAL CRITERIA 1. Strategic Alignment: The proposed LHIN-specific obligation reflects the system perspective and important goals or aspects of the regional or local health system. It aligns with one or more provincial and/or LHIN system imperatives, and with one or more health system outcome objectives. 2. Focus on Integration: The proposed LHIN-specific obligation enables greater integration within and across health sectors at the sub-region or LHIN level, with an emphasis on seamless transitions in care for patients. 3. Focus on Improvement: The proposed LHIN-specific obligation focuses on matters related to system outcomes, provider-specific performance, and quality improvement. *Note: The proposed LHIN-specific obligation is distinct from existing requirements and accountabilities. 46

Reminder: Purpose of LHIN Local Obligations (Schedule E 3 a) • Strategic Alignment: The proposed LHIN-specific obligation reflects the system perspective and important goals or aspects of the regional or local health system. It aligns with one or more provincial and/or LHIN system imperatives, and with one or more health system outcome objectives. • Focus on Integration: The proposed LHIN-specific obligation enables greater integration within and across health sectors at the sub-region or LHIN level, with an emphasis on seamless transitions in care for patients. • Focus on Improvement: The proposed LHIN-specific obligation focuses on matters related to system outcomes, provider-specific performance, and quality improvement. *Note: LHIN-specific obligations are distinct from existing requirements and accountabilities and are considered in the Performance Management Framework. 47

Appendix 3: Toronto Central LHIN Contact Information Performance Management Team Name Sheila Banks. Switzer Role Director, Performance Management Luciano Veta Manager, Contracts and Performance, Hospital MSAAs Andrea Tsuji Senior Consultant, MH&A Laurent Tyers Senior Consultant, SPO Nello Del Rizzo Senior Consultant, CSS Shama Umar Senior Consultant, Primary Care Email sheila. banksswitzer@tc. lhins. on. ca luciano. veta@tc. lhins. on. ca Phone 416 -2173820 ext 2596 ext 3223 andrea. tsuji@tc. lhins. on. ca laurent. tyers@tc. lhins. on. ca nello. delrizzo@tc. lhins. o n. ca shama. umar@tc. lhins. on. ca ext 3378 ext 2508 ext 3224 ext 3217 48

Appendix 3: MSAA Advisory Committee Member Scott Mc. Leod (Co-chair) Position Organization CEO CW LHIN President and CEO Chantale Le. Clerc (Cochair) Adrianna Tetley CEO CH LHIN Alliance for Healthier Communities (The Alliance) (Formerly Association of Ontario Health Centres (AOHC) Debbie St John-de Wit Executive Director Seaway Valley CHC (The Alliance member rep) Canadian Mental Health and Addictions Camille Quenneville Chief Executive Officer (CMHA) Ontario Steve Lurie Executive Director CMHA Toronto Gail Czukar CEO Addictions & Mental Health Ontario (AMHO) Reconnect Mental Health Services (AMHO Mohammed Badsha COO Shilpi Majumder Director of Public Policy member rep) Advant. Age Ontario City of Toronto (Advant. Age Ontario member Soo Ching Kikuta Director, Resident Care & Services Manager, Policy and Stakeholder Patrick Boily Engagement rep) Ontario Community Support Services 49 Association (OCSA)

Appendix 3: PSWG Membership Member Neil Mc. Intosh (Co-lead) Position Organization Director, Performance and Accountability CW LHIN Director, Performance, Contracts and Sue Turcotte ( Co-lead) Allocation C LHIN Jeanny Lau Lead, Health System Performance MH LHIN Jean-Francois Gauthier Performance ＆ Finance Analyst Senior Analyst, Decision Support Performance Contracts Allocations ESC LHIN Kelvin Luk C LHIN Financial Analyst Performance & Josh Clark Jason Lye Accountability National Director SW LHIN Independent Living Services, March of Dimes Canada Lanark Renfrew Health and Community John Jordan Executive Director Services Joshua Murray Manager, Policy and Research AMHO Aimee Juan Manager of Addiction Services Thunder Bay Counselling Centre Shilpi Majumder Director of Public Policy Advant. Age Ontario Matilda Kress Community Program Manager Region of Waterloo Ivan Lewis Director of Finance and Corporate Services CMHA Toronto Gary Thompson Team Lead MOHLTC 50

Appendix 3: IWG Membership Member Position Director, Health System Performance, Laura Salisbury (Co-lead) Funding and Contract Management Organization MH LHIN Elizabeth Salvaterra (Colead) Kevin Holder Pan-LHIN Lead LHIN Renewal Performance, Funding and Contract Management Specialist, Corporate Services NW LHIN Tiffany Britten Manager, Contracts & Accountability Waterloo Wellington LHIN Peng Liu Senior Finance Services Manager Ontario March of Dimes Sue Hillis Executive Director Dale Brain Injury Services Shilpi Majumder Director of Public Policy Advant. Age Ontario Heather Mihichuk Program Manager Jasper Place, Thunder Bay Laurie Fors Rachel Arbour Program Manager Regional Decision Support Specialist, Northern Region Jasper Place, Thunder Bay Centre de santé communautaire Sudbury-Est (Sudbury East CHC) Steve Lurie Executive Director CMHA Toronto Jesse Auguste Policy Analyst Addictions & Mental Health Ontario (AMHO) Domenic Della Ventura Team Lead, Performance & Accountability MOHLTC, LLB Manager - Capacity Planning and LHIN Nam Bains Ying Jiang Support Senior Policy Advisor (Acting) MOHLTC, HAB Health Analyst, Measurement and Decision Winnie Chan Support MOHLTC 51