In late February, government officials confirmed the rumours and announced a broad shift in the delivery of health-care in Ontario. As the dust settles, now we know: a new “super-agency” would merge 19 agencies together in one – including the 14 Local Health Integration Networks (LHINs) that have long overseen regional health-care and specialized sectors such as home care.
This is intended to deliver better health outcomes for Ontarians and halt spiralling health-care spending, and extends beyond LHINs to include eHealth Ontario, Cancer Care Ontario, Health Quality Ontario, HealthForce Ontario and the Trillium Gift of Life Network.
While critics denounce this as a move towards the privatization of health-care, for the home care sector in particular, not much has changed. That’s because here in Ontario, home care is already organized under a publicly-funded, privately delivered partnership model.
It’s time to dispense with the criticism and focus instead on the opportunity: to improve efficiency and deliver more patient-centric care.
I run Canada’s leading home care software company and, in our corner of the health-care world, it’s important we build the right seesaw of responsibility between private agencies providing a much-needed service, and the public system that must oversee the management of care and the responsible use of resources.
Redundancies help no one, least of all patients. For instance, we don’t need assessments performed by case public managers and then redone by clinical managers at private home care agencies. Instead, make the latter accountable for this vital function – after all, their nurses are fully qualified and members of the same professional associations.
Most importantly, Ontario patients deserve efficient, effective delivery throughout the care continuum, by newly-formed health teams that are free of artificial boundaries caused by funding silos. Allow capitated pay models to flourish: if a dollar spent in the community can save $10 in the acute care setting, those tremendous ROI community dollars need to be spent.
AlayaCare, whose technology serves 23 current Ontario home care providers and 128 community care providers, looks forward with optimism to harmonizing the province’s delivery of home care. There is, for instance, no reason that automated service provider reports that are issued electronically to LHIN case managers need to come in 14 different flavours.
Most importantly, for Ontarians to receive the home care they want, when they want it, open competition between providers must be permitted to flourish again. Contracting services across any number of industries to the private sector is meant to galvanize the effects competition has on quality and value – and when it comes to the intimacies of health care (rather than, say, garbage collection), it is an imperative.
For years, Ontario’s Community Care Access Centres were advised to avoid requests for proposals as a means to better manage the province’s relationship with service providers. Why? While service providers are measured by specific key performance indicators, when you have to compete for your customer – be it the end patient or the referral source – those who innovate and deliver better outcomes more efficiently will naturally rise to the top. Home care companies do a great job and want to compete for business by delivering the best care. Let’s give them that opportunity.
The private sector brings far more opportunity than it does risk.
Proven global track record
There’s no need to take my word for it: a quick glance internationally and we’ll see how Ontario’s model may play out in the coming years. Countries such as Australia and the U.S. have seen dramatic improvements and innovations in home care service delivery thanks to proactive government measures.
In the U.S., the Affordable Care Act introduced 60-day hospital readmission penalties under the Hospital Readmissions Reduction Program. As a result, home care providers who used to compete for referrals by bringing boxes of donuts to discharge planners are now investing in remote patient monitoring tools and data-driven care plans to demonstrate their value to hospital partners. Why? Because technology like AlayaCare is helping to reduce preventable readmissions by as much as 70 per cent.
In Australia, public funding for home care under the Aged Care and Disability Programs moved to a client-directed care (CDC) model completely in 2018. Home-care providers who were used to the government being their customer met a reality where recipients of care were now in charge of making the decisions – and could take their public funds to a provider of their choice. The result: a flurry of innovation and investment in step with the rest of the on-demand economy, where patients now have more control over their care plans, along with which caregivers visit, and when.
There’s no question that care is complex, and outcomes are hard to predict. But as the system finds its legs, it’s beneficial to see past grinding bureaucratic reorganization to the myriad benefits that can be realized by shifts set in motion by the ministry.
Competition fosters innovation. Home care, and health care overall, is about people. They are the focus, they are the “customers”, and there are tremendous opportunities to innovate when an open market is allowed to breathe, and the layers of bureaucracy are permitted to dissolve.
Adrian Schauer is CEO of AlayaCare, a provider of cloud-based home care software that offers a platform for home and community care organizations to propel towards innovation and home care of the future.