Canada: Designation Process For Ontario Health Teams
Health Law Bulletin

This is the next bulletin in our series regarding Bill 74, The People's Health Care Act, 2019. As of April 17, 2019, Bill 74 was on its third reading in the Ontario legislature, after previously being considered by the Standing Committee on Social Policy. If passed, Bill 74 will enact the Connecting Care Act, 2019 (the "Act").

As described in one of our previous bulletins issued on Bill 74, the Act will authorize the Minister of Health and Long-Term Care to designate certain individuals and entities as an integrated care delivery system ("ICDS").

ICDSs have been described by the Ministry of Health and Long-Term Care (the "Ministry") as "[...] a new model to integrate care and funding that will enable patients, families, communities and providers to better work together."[1] In follow-up to the Act - which provides limited guidance as to how ICDSs will be designated - the Ministry published resources explaining the designation process for ICDSs, which are referred to by the Ministry (and will be referred to below) as "Ontario Health Teams".

The purpose of this bulletin is to provide an overview of the application process for Ontario Health Teams.

Significant dates in respect of the process for designation as an Ontario Health Team are included at the end of this bulletin. Those interested in applying for such a designation should be aware of the forthcoming application deadline.

Who Can Apply to Become an Ontario Health Team

As part of the additional resources it made available in respect of Ontario Health Teams, the Ministry published Ontario Health Teams: Guidance for Health Care Providers and Organizations (the "Guidance Document"). The Guidance Document sets out the process for applicants to respond to the Ministry's open invitation to "providers" to demonstrate their readiness to become an Ontario Health Team (or part of an Ontario Health Team). The Guidance Document describes Ontario Health Teams as being "groups of providers and organizers that are clinically and fiscally accountable for delivering a full and coordinated continuum of care to a defined geographic population" and includes a non-exhaustive list of services that Ontario Health Teams will be expected to deliver at their maturity, including, for example, primary care, secondary care, home care, palliative care and emergency health services.

Significantly, through the Guidance Document, the Ministry has:

• expressed its objective of having all health service providers[2] eventually join or become Ontario Health Teams;[3]
• indicated that the assessment process (described below) will be repeated until full provincial coverage of Ontario Health Teams is achieved; and
• stated that applicants that are not ready to participate in the first round of the assessment process will have further opportunities to participate, with additional dates to be announced by the Ministry.

Path to Designation as an Ontario Health Team

Becoming a designated Ontario Health Team involves 4 steps:

1. Self-Assessing Readiness
2. Validating Provider Readiness
3. Becoming an Ontario Health Team Candidate
4. Becoming a Designated Ontario Health Team

Self-Assessing Readiness

All interested providers and organizations are invited to complete and submit a self-assessment form.[4]

Validating Provider Readiness

Initial Assessment 

Based on an applicant's self-assessment form, it will be identified as falling into one of two categories:

1. "In Discovery" - applicants who do not demonstrate a high degree of readiness; or
2. "In Development" - applicants who demonstrate a higher degree of readiness.

Applicants determined to be "In Discovery" will not be invited to submit a full application but will receive supports (for example, forms, data and analytics) to increase their readiness. Applicants determined to be "In Development" will be invited to submit a full application.

Notably, the Guidance Document specifically contemplates that the Ministry may ask applicants to collaborate / join with additional applicants and re-submit a joint self-assessment.

Full Application & In-Person Visit 

Applicants that are invited to make a full application will be required to submit a full application to demonstrate their ability to meet the "Candidate readiness criteria".[5] Applications (which will be provided to those applicants that have advanced to this second stage) will be evaluated, and those that demonstrate a higher degree of readiness for implementation will be invited for an in-person visit.

Through an in person assessment, applicants that are "demonstrably ready" to become candidates for Ontario Health Teams will be identified. Though further requirements of the visit will be shared with invitees, the Guidance Document provides that applicants will be expected to present a thorough current state assessment of their model and short and long-term vision for the future of patient care at the in person meeting.

Becoming an Ontario Health Team Candidate

Applicants that demonstrate that they meet the critical readiness criteria through the invitational application and in-person visit, will be selected to begin implementation of the Ontario Health Team model and will be referred to as "Ontario Health Team Candidates".

Becoming a Designated Ontario Health Team

Candidates that are deemed prepared to receive an integration funding envelope and enter into an accountability agreement are qualified to be designated as an Ontario Health Team.

Maturation of Ontario Health Teams

The Guidance Document contemplates that it will take several years for Ontario Health Teams to be fully operational across the province, and that the government will take steps to ensure that transitions occur over time with the goal of providing seamless patient care.

Appendix B to the Guidance Document sets forth the Ministry's very detailed expectations of:

• Applicants to become "Ontario Health Team Candidates"[6]
• Ontario Health Teams Candidates following their first year of operations
• Ontario Health Teams at maturity

In each case, the expectations fall within 8 categories:

1. Patient Care & Experience
2. Patient Partnership & Community Engagement
3. Defined Patient Population
4. In-Scope Services
5. Leadership, Accountability, Governance
6. Performance Measurement, Quality Improvement & Continuous Learning
7. Funding and Incentive Structure
8. Digital Health

The specific expectations for each of the three stages (i.e. to become a candidate, Ontario Health Team - 1 year out, and Ontario Health Team - at maturity) can be accessed here by selecting "Ontario Health Team Guidance Document".

Stay tuned for subsequent bulletins setting out further details of Ontario Health Teams, such as the applicable funding and governance models.

Important Dates for Applicants

[1] See: 'Ontario Taking Next Step in Building a Connected Public Health Care System for Patients'.

[2] The Guidance Document refers to applicants as "health service providers". However, it is unclear whether the Ministry's intention was that this term: (i)  has the meaning ascribed to it in the Act; or (ii) would refer generally to health providers (organizations and individuals). The Act does not clearly limit the composition of Ontario Health Teams to health service providers, stating that "The Minister may designate a person or entity, or a group of persons or entities, as an integrated care delivery system." [Emphasis Added]

[3] This objective highlights an important point that Ontario Health Teams may be comprised of a single organization provided that the organization delivers at least three of the services prescribed by section 29(2)(a) of the Act (and otherwise meets any future prescribed conditions and requirements).

[4] This form can be accessed here.

[5] Additional details of these criteria are included below under the heading, "Maturation of Ontario Health Teams". The full list of criteria is set out in Appendix B to the Guidance Document.

[6] As further detailed above under the heading "Full Application & In-Person Visit".

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.