The Ontario health care system is in distress. Frontline health care workers like myself know this. Many of the rules that we are forced to abide by are archaic and make no sense. Outdated fax technology only flourishes in health care. Hospitals are bursting at the seams. Home care is proving woefully inadequate. Sadly, patients are suffering from the consequences. This is what 15 years of neglect and lack of foresight by the previous Ontario Liberal government has caused.
To fix the situation, the new Conservative government of Premier Doug Ford is proposing what has been called the most massive transformation of health care since Medicare. The first step is to form an agency– called Ontario Health – that will merge up to 20 different agencies into one. Long-time fans of mine (all three of them) will know this is music to my ears. It was step three in the seven-point plan I urged then-Premier Wynne to follow to fix health care back in 2017. I can’t help but be pleased this is finally happening – and certainly expect a significant reduction in Ontario’s bloated bureaucracy as a result.
The second step is to form a number of “Ontario Health Teams”(OHTs). The goal of these teams is to provide Integrated Care Delivery Systems (ICDS). There’s a lot of bureaucratic verbiage in the documents released to date, but essentially the goal is to ensure that different health care providers (doctors/home care/hospitals, etc.) work seamlessly to deliver care to patients, as they move through the health care system. I know, it sounds incredibly basic, and should be straightforward, but unfortunately, it just doesn’t happen as well as it should right now
Can OHTs work? As always, the devil is in the details. The first thing that is needed is the political will to transform the health care system. This is clearly evident. Health Minister Christine Elliott has been widely lauded as a very capable minister and truly has the ability to provide the political will necessary. Dr. Reuben Devlin (the Chair of the Premier’s Council on Ending Hallway Medicine) is a strong leader as well. Thankfully, the person who will have to do a lot of the bureaucratic heavy lifting is new Deputy Minister Helen Angus. I’ve written about her before, and she certainly appears to be a very strong deputy minister. I think she’ll do very well.
The next step is to ensure that similar models across the world are studied, and only the successful ones copied. You see, the OHTs appear to be the Ontario version of something called Accountable Care Organizations (ACOs – I know, you have acronym overload by now). The goal of ACOs is to provide an amount of funding to a geographic region, and to have all of the health care delivered to patients in that area paid for by that funding. The OHTs however, appear to be taking a more cautious, pragmatic approach, and are only going to provide funding for outpatient services, and not include physicians’ services. They may evolve in the future, and it’s a smart move on the government’s part not to move too quickly.
Now, the reality is that only some ACOs worldwide actually meet the goals of simultaneously improving health care while reducing health care costs. So it’s incumbent upon OHTs to reflect those effective models, and not the ones that have failed. What do the successful models have in common?
First, it is essential to have strong physician leadershipin these models. For too long, Ontario’s physicians have been blocked from providing advice to the government. Physicians work on the front lines of health care delivery, and see the effects of bad policy every single day. They have many ideas on how to transform health care for the better. The previous Liberal government only viewed front line health care workers as eye candy for photo ops and nothing more. Thankfully, this seems to be changing, and it was refreshing to have Premier Ford’s Senior Advisor Greg Harrington come to visit us at the Ontario Medical Association head office last week (I can’t recall anyone from Kathleen Wynne’s office visiting us). Governments co-operating with physicians can only help patient care.
Secondly, the mess that is Ontario’s IT infrastructure needs to get cleaned up quickly. You see in 2019, for seamless care to be provided to patients, hospitals need to talk quickly, securely and electronically with home care providers. Doctors need to talk to pharmacies. Nursing homes need to get doctors quickly. In short, the relevant data has to follow the patient. Projects like the one I was proud to spearhead in Georgian Bay have proven that we can save money and provide better health care at the same time.
These are challenging times in health care, but there is also a great opportunity. By properly instituting OHTs, Ontario has a chance to finally start reversing its poor record of the past 15 years. Done properly, this reform of health care could also be a lasting legacy for Premier Ford.
Let’s get it done right.