The Pandemic Response: An implementation runway for OHTs

The optimist in me always tries to find a silver lining, even in the darkest of times. Lately, this tendency has had me reflecting on the changes and innovations to our province’s health care system through its response to COVID-19. Ontario’s health care system is no stranger to change, with or without a pandemic. Just last year, Ontario’s health care system started on a transformation journey that, if successfully implemented, would help deliver patient-centred, coordinated care for Ontarians through integration and collaboration amongst providers from different health care sectors – a move towards true population health management via Ontario Health Teams (OHTs).

Even though the pandemic has delayed the implementation of the Year 1 OHT model for the selected ‘first group’ of 24 OHT candidates, it’s clear that the spirit of the transformation has already taken root within Ontario’s health care system. When examined closely, it turns out that there are many similarities between the proposed OHT model and how the Ministry of Health (MOH), Ontario Health, and health care providers have mobilized to provide care for Ontarians during this pandemic. Consider these core principles of the OHT approach: 

• Providing the right level of care, in the right setting, at the right time: The delivery of COVID-19 care is based on a risk stratification model where the patients are screened for symptoms in a home/community setting, and – depending on the severity of their symptoms – they are then navigated to the right care setting. For example, the drive-thru centre near Etobicoke General Hospital tests more than 100 people per day for COVID-19 symptoms, and those with severe symptoms are encouraged to go to a hospital. There are dozens of similar drive-thru centres in the province, and they are proving to be more accessible and approachable than an emergency department. Patient-centric innovations like this would feel at home in any OHT’s integrated model of care, independent of the ongoing pandemic. The ability to provide the right level of care, in the right setting, at the right time, is also evident through the virtual delivery of non-COVID care. The pandemic is proving to be a catalyst for providers, especially primary care physicians, to identify the services that can be delivered virtually, which could become the new normal.  

• Taking a digital-first approach: COVID-19 has disrupted many of the traditional ways patients access care, whether primary care, in the community, or at the hospital. Better, more accessible virtual care is proving to be a powerful tool in the COVID-19 response. It is helping primary care physicians screen patients, gather patient history, assess symptoms, monitor progress, and connect with other providers. The digital-first approach of virtual care is allowing providers and patients to connect safely at a distance, minimizing the risk of community infection. Further, these services are being standardized and made scalable. For example, William Osler Health System has developed a virtual consultation program for Long-Term Care (LTC) homes in its OHT area. This program uses the Zoom platform and a dedicated phone number for the LTC homes to provide fast access to virtual consultations with Medical Specialists and the Nurse Practitioner Led Outreach Team, allowing for a potential reduction in the need for a hospital visit for frail and vulnerable seniors. The creation of temporary virtual care billing codes (K codes) by MOH is proving to be a critical enabler for the adoption of virtual care to aid in the COVID-19 response. Although temporary, these codes could allow the MOH to assess the efficacy of virtual care billing, encourage the adoption of virtual care for providers, and set a foundation for OHTs. The ‘digital-first’ approach, in particular, virtual care services, is a critical part of the OHT model. While last year we lacked the stimulus for a shift in how primary care could be delivered virtually, COVID-19 has created an environment where the ‘digital-first’ approach is becoming the norm – and both patients and providers are benefiting from the change. We are also witnessing an increase in staff working remotely and virtual coordination amongst providers. The saying ‘necessity is the mother of invention’ certainly applies here.

• Promoting the adoption of safe, effective, and innovative practices: Many innovative models have been implemented in the past few months to deliver health and wellness services, especially to support seniors. An example that showcases this new drive for innovation and a multi-disciplinary approach is the Long-Term Care Collaboration Outreach group in East Toronto (East Toronto Health Partnership). This multi-disciplinary team draws upon the infection prevention and control experience of Michael Garron Hospital and shares its expertise with on-the-ground support workers to provide preventative and supportive care for seniors in LTC homes. This team also has physicians and nurses who are focused on providing required support at the LTC homes to reduce instances of hospital transfers. Again, while this push for innovation stems from the pandemic, the need for greater collaboration and multi-disciplinary / inter-professional teams already existed in Ontario and was a part of the OHT model. Present circumstances have heightened the need to change, and Ontario’s health system has innovated at speed as a result.

• Adopting digital options for decision support, operational insights, population health management, and tracking/reporting key indicators: Health care providers and MOH have developed dashboards to measure the progress and success of COVID-19 response activities. The operational insights from the data are helping inform the development of programs/services at the provider level, as well as policy changes and provincial programs, such as the procurement of personal protective equipment (PPE). The province is also witnessing innovation in the use of data to inform workforce planning and decision support. For example, a team of researchers from the University of Toronto has developed a tool that helps hospitals efficiently utilize their resources during COVID-19 by rapidly matching available staff to openings. Another team from the University has also developed an interactive tool that allows providers to estimate their capacity to manage new COVID-19 cases. The use of data in decision-making is not new to Ontario, but what we’re currently witnessing is the use and sharing of this data at the network level to deliver coordinated care and drive change. This ability is a critical prerequisite to real, effective OHTs, and Ontario will be coming out of this pandemic with real experience on how to make it work.

• Encouraging and enabling healthy behaviours and activities that promote physical and mental health and well-being: In the wake of the pandemic, several providers across the health and social care system are offering virtual programs to help improve physical health, mental fitness, and social connections for their patients. For example, Community and Home Assistance to Seniors, a provider in the York and South Simcoe region, is offering virtual wellness programs for seniors from the safety of their homes. They also provide a suite of services, including grocery shopping and essential in-home care services, for their clients. Further, MOH has committed $12 million towards mental health during COVID-19. This funding is being used to help mental health agencies hire more staff, procure necessary equipment and technology, and enable the creation and enhancement of virtual and online services for patients and health care workers in need of mental health support. For example, OTN’s Big White Wall is now a free online mental health service for Ontarians 16+. The deep connection between social supports, mental health, and physical health has long been known to the health care sector. The inclusion of social support providers into OHTs makes clear the intention for OHTs to promote the holistic health and well-being of their population. The long-needed breakdown of silos between health and social care has already started as a result of the pandemic response.

Beyond the points above, we are also experiencing investment and innovation from the private sector, not only in health care but also from other industries. For example, the hospitality industry is providing hotel rooms for front-line workers, the fashion industry is re-purposing its production facilities to make hospital gowns and masks for doctors and other health care workers, and several other industries are making financial contributions to support the health care system’s response to COVID-19. These examples shine a light on the potential for public-private partnerships to provide innovative services and supports that enable a population health approach.

Based on these reflections, it’s clear that the COVID-19 pandemic hasn’t truly delayed the OHT transformation, but instead channelled and even heightened the innovative spirit throughout Ontario’s health care system. But the pandemic will end, and the OHT transformation will need to continue. Therefore, my challenge to the OHT candidates is this: start thinking about how you can scale and sustain the momentum created through the response to the pandemic to set your network up for a successful OHT Year 1 implementation. It is possible to hold the gains!

While many potential areas of focus can help OHTs work towards this goal, five areas of focus in the short-term for OHTs are to:

1. Identify the elements of the Year 1 OHT model that have been accelerated through the COVID-19 response, and develop a plan to embed and scale them to achieve the OHT’s goals;

2. Standardize the implementation of virtual care services, and develop leading practices to scale and sustain the changes/innovative practices across the OHT;

3. Develop guidelines for providers across the OHT network to standardize the collection of data and to use the data to develop strategic and operational insights for the OHT;

4. Identify areas of successful partnership with social service providers to deliver health promotion and prevention programs; and

5. Build on the innovative, agile, and digital-first mindset of health care providers in the OHT network to implement the Year 1 model successfully.

There’s my silver lining. What do you think OHTs should build on from the pandemic response to enable a successful OHT Year 1?