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Integrated Care in Ontario: Unicorn or Black Swan?
Abstract
The movement away from traditional models to organize, finance and deliver healthcare toward integrated models focusing on delivering value has been under way in many health systems and jurisdictions in the world with varying degrees of intensity and success for much of the past 20 years. I have had the opportunity to lead aspects of a multi-state health system committed to the concepts of accountable care during the first 10 years of the Patient Protection and Affordable Care Act (PPACA) in the US. For the past two years, I have assumed the role as CEO of a large academic health sciences centre in Ontario as the province embarks on a shift in policies to support integrated models of care delivery similar to those associated with the PPACA. I will describe my observations comparing two countries' move toward integrated delivery models and potential lessons for Canada.
... Perhaps the most sensible starting point is to break down the silos between healthcare and social care. Although initiatives to meaningfully integrate healthcare and social care are under way in a number of countries (Drewes et al. 2017;Harlock et al. 2020), similar policies have failed to gain traction in Canada's provinces, although there are some indications that Ontario's The People's Health Care Act, 2019 (Bill 74) is setting the stage for community-based integration of healthcare and social care providers (Downey et al. 2020;Woods 2020). ...
Canada is one of the world's highest per capita spenders on healthcare. Yet provinces consistently boast lackluster performance on important measures of their population's health and access to healthcare (Davis et al. 2014; Doty et al. 2020). Spurred by public reporting, unease among governments about how to fix the problem and the lack of obvious solutions, much discussion focuses on improving the "value" of spending on healthcare (Papanicolas et al. 2018; Shrank et al. 2019).
... In an article that emphasizes challenges to significant reforms taking shape in Ontario, Woods (2020) juxtaposes personal leadership experiences in the US with characteristics of Ontario's health ecosystem. Noting that Ontario's providers, and healthcare sectors, have conflicting financial incentives that have led to bottlenecks, coupled with a lack of experience with capitated funding models, Woods concludes that OHTs will face substantial challenges moving from silo-based models. ...
Patients, caregivers, providers, provider organizations such as hospitals and provincial government funders each have their perspectives on how and when healthcare should be delivered and have expectations for its quality, convenience and efficiency. These competing viewpoints on the value from healthcare have led many to wonder: what is the path for improving value from healthcare in provinces?
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