Momentum Grows for Value-Based Care in Mental Health in Ontario

In March 2021, the Ontario Hospital Association (OHA) published an article in Health System News describing Ontario's difficult, decades-long journey towards a value-based funding model for mental health and addictions care. We also introduced the new Mental Health and Addictions Funding Initiative, coordinated by the OHA on behalf of the Hospitals Advisory Committee (HAC) to explore funding approaches that support and incentivize improved quality of care for Ontarians. Almost a year later, we are pleased to report on its progress.

The initiative continues to move forward thanks to the contributions and dedication of an advisory committee and three working groups made up of members from over 20 hospitals, community mental health organizations, the Ministry of Health, Ontario Health and its Mental Health and Addictions Centre of Excellence, as well as academic and research institutions. Together, they have spent the past year exploring ways to overcome challenges and make exciting progress toward their ultimate goal of building a funding methodology that can improve quality of care for patients and their families, throughout the patient journey.

One of those challenges is finding a manageable and high-impact starting point, which can act as a springboard to broader change. For this reason, the committee chose an initial focus on inpatient activity related to people who have schizophrenia, with the goal of linking its hospital-based quality standard to funding. Future stages of the project will build on this work to encourage integrated care and seamless transitions between hospital and community-based care.

The quality standard contains 11 quality statements recommended by a panel of experts and patients and is intended to enable clinicians to provide standardized care. Members of the initiative recommended an approach beginning with a few key quality statements, with others to be added as the methodology evolves. In spring 2021, they narrowed in on four specific statements under the standard, based on their value to patients and the system, as well as their measurability for performance management:

• Statement 6: Treatment with Clozapine
• Statement 7: Treatment with Long-Acting Injectable Antipsychotic Medication
• Statement 10: Follow-Up Appointment After Discharge
• Statement 11: Transitions in Care

Next, the committee selected a corresponding approach to incentivize improvement. After reviewing a range of existing value-based funding methodologies, they chose one based on Ontario's successful Emergency Department Pay-for-Results (ED-P4R) program. They leveraged the funding model and adapted it to appropriately link quality to funding for adults with a primary diagnosis of schizophrenia or schizoaffective disorder. Together, the four quality statements and this approach established a short-term plan that would allow the field to get started.

Another historical barrier to new funding approaches to mental health and addictions in Ontario has been the relative absence of high-quality data collected in mental health compared to other types of care. For this reason, one of the recommendations from the 2017 report from the Inpatient Mental Health Funding Task Group was a strategy to improve data quality and reporting. The Administrative Data Quality Working Group was tasked with finding ways to access or collect the data needed to get the initiative off the ground.

While one of the four indicators was already collected and accessible through ICES, primary data collection was necessary to calculate the remaining three quality indicators. In June 2021, the Ministry of Health sent a request to hospitals asking them to compile this data retrospectively. The OHA facilitated a technical webinar with clinical leadership to support members during this primary data collection.

Based on feedback from the field on their experiences collecting this data, it was decided that a more convenient and standardized approach was necessary going forward. The Ministry of Health and the OHA worked with the Canadian Institute for Health Information (CIHI) to enable prospective collection of the necessary new data elements under the existing Ontario Mental Health Reporting System (OMHRS) effective April 1, 2022.

In the meantime, the existing primary data collection is being put to good use. In December 2021, the OHA launched a new Mental Health and Addictions Quality Standard – Schizophrenia Care Dashboard. Accessible via the OHA's Data and Analytics platform, the dashboard allows hospitals to compare their performance with peers and can be used for performance measurement and quality improvement purposes.

What's next for the initiative? The advisory committee is in discussions with HAC and partners at the Ministry of Health and Ontario Health to use the existing data for performance measurement and benchmarking purposes. It would measure quality and improvement of care that would eventually be linked to funding for schizophrenia. Simultaneously, they are pursuing opportunities for complementary exploratory work in the community mental health sector, with the goal of ensuring patients are supported across the continuum of care.

Over the past year, this initiative has proven that leaders, administrators and clinicians are ready, willing and able to collaborate to improve mental health and addictions care, overcoming difficulties that may have held us back in the past. We have begun to carve a new path forward in Ontario's journey and look forward to continuing to build momentum for quality improvement and value-based care in mental health and addictions care in Ontario.

Learn more about the Mental Health and Addictions Funding Initiative. With any questions, please contact pbf@oha.com.