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Ontario’s High-Needs Patients: Can Health Links Reach Them All?

It’s a well-known problem. A small percentage of Ontario’s patient population accounts for a large percentage of health care spending. The province’s Health Links initiative was designed to fix this issue – but how well is it working?

In the years since they were introduced, Health Links have had a positive impact on the lives of high-needs patients. Care coordination has improved. These networks have been successful because they’ve expanded quickly. But they haven’t expanded quickly enough.

The demand for coordinated, patient-centred care is rapidly growing. Unfortunately, the health care budget isn’t. Could an existing initiative really provide the answer?

This post will look at solutions to a potential health care crisis. We’ll also explore the bold ambition of a Local Health Integration Network (LHIN) that’s putting its faith in Health Links.

The Need

If you work in health care, you’ve heard the statistic. Just 5% of Ontario’s population accounts for almost two-thirds of the province’s health care spending. A mere 1% accounts for one-third of spending.

The costs of treating our system’s high-needs users are astounding. In order to find solutions, the government has worked hard to understand who these users are.

As it turns out, they’re very often people who have multiple chronic conditions. A recent figure puts the average cost of care for a patient with more than four of these conditions at $21,540. In contrast, the average cost for a patient who falls beneath this threshold is $1,240.

At a time when chronic conditions are rising rapidly, these numbers are cause for alarm.

Also worth noting: most of the 1% are over the age of 65. Of course, the vast majority of older adults aren’t high-needs users. But the fact that they comprise most of this category is significant. It means that, as the population continues to age, Ontario will have to deal with a major influx of high-cost users.

None of this bodes well for the province. Luckily, health care leaders are aware of just how dire the situation is – and they’ve begun taking action.

The Health Links Solution

Health Links was announced in 2012. The concept behind the initiative was simple: to provide better-coordinated, more person-centred care for Ontario’s highest-need patients.

If you’re reading this post, you’ve probably been watching the progress of Health Links with interest. And there’s good reason to pay attention. In a few short years, the number of regional Health Links has grown from 19 to 82. Just as impressive, 18,926 complex patients have received coordinated care plans since the initiative launched.

Needless to say, the province has made great strides in care coordination. But these improvements are just the beginning. To meet rapidly-growing demand, Health Links must continue to grow.

The Local Health Integration Network (LHIN) in Champlain understands the need for expansion. Recently, the health authority announced its intention to serve 10,000 complex patients through Health Links by the end of 2019. Currently, there are 560 regional participants. By any measure, this is a very ambitious goal.

In a recent Ottawa Citizen article (linked in the previous paragraph), the LHIN’s CEO described the need to take bold action. “[C]ontinuing to hope for additional money and adding more money to what we’re already doing, it’s just not realistic anymore”, said Chantale LeClerc.

In the coming months, LHINs across the province will have no choice but to rapidly scale their care coordination efforts. In short, they’ll have to bet on Health Links.

Of course, skilled professionals are the sector’s greatest resource. According to the Citizen, over 900 primary care physicians need to participate in Health Links by 2019 (that number is currently 156).

Perhaps even more dauntingly, the LHIN will have to hire 102 care coordinators within the next three years. The cost? $11 million dollars.

Luckily, there’s hope. By improving standardization and implementing efficiency-enhancing innovation, Ontario’s LHINs can make the most of Health Links resources.

Ramping Up Coordination – Not Costs

Let’s look closer at the critical work carried out by care coordinators. To plan for the care of any given patient, a coordinator relies on timely and accurate information from many sources. She may need to interact with entire care teams, including patients and their family caregivers.

The job is difficult – and essential. When it comes to preparing Health Links for the approaching wave of high-needs patients, more productive care coordinators is key.

Consider the following scenario. Joe is a Health Links client. He has COPD, heart disease, cancer, diabetes, and depression. He has 40 physicians and specialists on his care team, including primary care doctors, an oncologist, an endocrinologist, a respiratory therapist, a psychologist – the list goes on.

How much time will Joe’s care coordinator need to devote to assessing his care and his progress? The answer will depend, to a large extent, on whether feedback and updates are readily available.

What if the coordinator were able to check in with Joe face-to-face to discuss his care – anytime, and from anywhere? What if she could hold virtual conferences with members of his care team? What if every time she accessed his coordinated care plan, she knew she was looking at his comprehensive (and up-to-date) health information?

With the information she needs right at her fingertips, Joe’s coordinator could provide the same high-quality, personalized care she always has – all in a fraction of the time.

Multiplying Care Coordinator Productivity

By improving communication across circles of care, digital technology has the potential to make care coordinators far more productive. As an example, let’s look closely at videoconferencing, one of the most promising classes of technology for care coordination.

Coordinators need to stay in touch with care teams and clients to ensure they have crucial information when they need it. Advanced videoconferencing technologies can be conveniently accessed on mobile devices – such as tablets and smartphones.

As a result, care coordinators can discuss critical, real-time developments with a client’s care team – no matter where team members are. The time that’s saved through instantaneous communication is truly amazing.

When it comes to Health Links, we can’t forget the patient’s point of view. The right videoconferencing app will be highly intuitive and easy for everyone to use – including those with complex needs. Instead of playing catchup after the fact, coordinators can hear clients discuss personal developments as soon as they occur.

Of course, there’s no shortage of useful communication and information-sharing tools. Choosing the right one will drastically cut down on the time coordinators spend tracking down crucial health information.

Care team members should be able to access and update care plans in real-time. Coordinators should always have the right information they need in hand. And of course, patients – and their trusted family caregivers – should be able to access their care plans easily.

The Bottom Line

It’s common sense, really. Less time per client translates into more clients served – all without reducing quality of care.

For the most part, LHINs appear ready and willing to explore innovation. But now, it’s time for these organizations to more fully embrace information and communication technology. It’s time to integrate efficiency-enhancing tools into every step of the care coordination and delivery process.

Feature image courtesy of Wonder woman0731

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