June 6, 2019
By Heidi Singer
If you’re curious about the new Ontario Health Teams – how to form one, what they will look like, how they will work, and why they may transform care in the province – few people know more about them than Walter Wodchis.
A professor in the Institute of Health Policy, Management and Evaluation (IHPME) at U of T’s Dalla Lana School of Public Health, Wodchis has been following the teams’ development closely, and is still evaluating the success of their predecessor, Health Links. He is an expert on coordinated care, the concept that the teams are based on.
Wodchis, along with fellow IHPME professor G. Ross Baker, is hosting a symposium on integrated care June 14 geared toward helping health professionals understand the new teams. He spoke with writer Heidi Singer.
What is integrated care?
I work off a definition that describes coordination of care across multiple providers with strong communication, shared responsibility, and strong engagement and involvement of patients and caregivers. In lay terms, it’s about making sure that people’s care is really well-organized across multiple providers and there’s usually a coordinator for that care or it’s well-known amongst those providers who’s responsible for what. And the care is organized around the patient’s needs.
This is opposite to what we have right now, which is isolated subspecialist care delivered in isolation across multiple providers – people doing their own thing and not paying attention to what everyone else is doing.
Is anyone in the world providing integrated care successfully right now?
I think there are quite a number of examples of well-integrated care, but almost all of these are locally developed models. I don’t think there are strong examples of systems that are highly integrated.
You could argue you get fairly good coordinated care in some American systems like the California managed care insurance company Kaiser Permanente. Here in Toronto, the South East Family Health Team operates in collaboration with their local hospital and LHIN. Carefirst, the community service agency, is similar.
Does the research show integrated care is best?
Absolutely for the frail elderly and anyone with complex health-care needs. I don’t think I require integrated care yet, but people who are trying to manage multiple conditions – diabetes, COPD, maybe some dementia or depression – coordinated care is better for their health and for the system’s health.
Then why hasn’t integrated care worked on a systems level?
That is the $64 million question.
There are a lot of reasons. Often a lack of sustained vision and priority on this – system leaders just don’t want it enough. Most of the programs we see that work are bottom-up: local people who are just trying to do a better job for their patients. On a systems level there’s a fear it will just add cost. And people don’t want to implement something that comes from somewhere else. Most people would see this as adding more work and resources, and they don’t know what they could give up to make space for this.
But we can gain resources in the health system. Choosing Wisely, the campaign to educate providers and patients about overtesting and overtreating, is one starting point.
How would you describe the new Ontario Health Teams?
Moving to this kind of coordinated care is a massive transformation goal. I often think of Ontario Health Teams as Health Links on steroids. Health Links was about forming a team around the most frail, complex patients and wrapping them in care. This is more ambitious because it’s about serving the entire population – eventually.
But there’s not going to be one model of a team at the outset. It might be a large family health team or hospital whose leadership decides to link up with services that provide home care, mental health care, or whatever the community particularly needs. Or it could be the home care agency that forms the team. Or anyone who’s involved with care. But they don’t have to start with the most complex patients. They could start with people who have depression and chronic medical conditions, for example.
They need to have the vision that they’re going to advance to the whole population. But on day one that’s beyond scope.
What will people learn at the symposium?
The symposium will provide essential knowledge on how providers and patients can work together to implement Ontario Health Teams. Our speakers are a mix of academic researchers and front-line providers, people who have experience in implementation. It’s going to be very practical. And we’ve asked all our speakers to provide their top three recommendations for the success of the health teams.
What are your three?
Gather together the people you need to work with. Agree to a common vision and set of principles that you can always lean back on for your planning and implementation work. And then you need to build trusting relationships with all your team members. Once you’ve done that, you can decide on priorities, and you’re on your way.
The symposium, Essential Ingredients of Integrated Care, will take place June 14, from 9 to 4:30 pm at the BMO Conference Centre, Toronto Western Hospital. Registration of $350 includes lunch, refreshments and a reception. Register here.