Ontario’s nurses call on government and stakeholders to collectively strengthen our publicly-funded, not-for-profit health system and make it more responsive to the public’s needs, easier to navigate and more efficient and cost-effective. To make this happen, focus must be placed on advancing primary health care for all through health promotion, disease prevention, social and environmental determinants of health and community care.
Equally important are changes that enable nurses and all other regulated health professionals to work to their full scope of practice, a commitment to reducing structural duplication, and advancing system integration and alignment.
Ontario’s Action Plan for Health Care supports a continued shift of care delivery to the home and community settings to improve patient outcomes and system cost-effectiveness. However, the ability of government to achieve a robust community care sector and health system cost-effectiveness is seriously hampered by existing duplication and excess structure.
Today, Ontario’s home health-care and support services are organized by 14 Community Care Access Centres (CCAC) that utilize nearly $2 billion of public resources each year. In 2008/09, $163M in operational and administrative costs was expensed by CCACs, demonstrating significant growth in administrative budgets that outpace growth in direct care dollars. At the same time, duplication and role conflict exists between CCACs, primary care, acute care hospitals, home health-care providers, support service providers, and Local Health Integration Networks (LHINs).
Given the growing maturity of LHINs and the primary care sector, the time has come to fully advance health system integration and eliminate unnecessary duplication, by transitioning the functions of CCACs into existing structures within the health system over the next three years – a proposal outlined in Enhancing Community Care for Ontarians (ECCO) model. Using the analogy of an eco-system, RNAO has created a responsive model that is meant to reflect the realities and interactions between people and their communities, within the context of primary health care. The model does not propose a one-size-fits-all approach to community care; rather it provides a conceptual template that can be localized within the specific geographical and community context where it is applied.
The ECCO model proposes that interprofessional primary care organizations, such as Community Health Centres (CHC), Nurse Practitioner-led clinics (NPLC), Aboriginal Health Access Centres (AHAC) and Family Health Teams (FHT) expand their reach and role over the next three years, with the support of a temporary LHIN-led Primary Care Transitional Secretariat to organize local geographic primary care networks. The ECCO model proposes that by 2015 primary care organizations will provide complete care co-ordination and health system navigation for all Ontarians, including the referral for home health care and support services, thus eliminating the need for CCACs. Current Registered Nurse (RN) case managers and care co-ordinators working within CCACs, would transition to the primary care setting and contribute their high level of expertise and system knowledge to provide dedicated care co-ordination and health system navigation to Ontarians with the most complex care needs. The remaining population will receive care co-ordination from a combination of existing primary care RNs, non-RN case managers/care co-ordinators and other qualified primary care providers.
The ECCO model maintains the current salary and benefits of CCAC case managers and care co-ordinators, using the current funding envelope available, as direct employees of primary care organizations. The model will strengthen the ability of these professionals to effectively lead care co-ordination and system navigation across the care continuum, with an intense knowledge of their clients from “womb to tomb”, without being burdened by the overwhelming administrative tasks that are a foundation of their current role in CCACs. The ECCO model assumes expertise of home health-care and support service providers, and their individual and collective commitment to clients and the health system. The mode leverages these strengths to empower a greater sense of professional autonomy in the planning and delivery of service to Ontarians, ensuring optimal client/family/provider engagement, service satisfaction, and provider accountability.
This white paper presents a model that advances a robust foundation for community care and improves integration between all health sectors through a single health system planner and funder – the LHINs as maturing system structure. Specifically, the paper provides an overview of the ECCO model to inform and evolve strategies to ensure timely access to Ontario’s health system, improve client experience and outcomes, and deliver comprehensive services in a cost-effective and seamless manner.
To read the full report, "Enhancing Community Care for Ontarians (ECCO) - A Three Year Plan (White Paper), please see below.