Abstract
Background: Seven Ontario Health Teams (OHTs), each a group of cross-sectoral health service organizations, were chosen by the Canadian province of Ontario to lead the modernization of home and community care. At the heart of this work lay the reconceptualization of care coordination, with a focus on integration. We explore how Ontario’s Ministry of Health (MOH) sought to modernize care coordination through its guidance to OHTs, OHTs’ own innovations, and the potential and limits of these efforts.
Approach: While our broader goal was to understand the key elements of each home care model and what helped and hindered its development, we focused the analysis of data collected from May to October 2024 on OHTs’ care coordination efforts. During this time, we conducted semi-structured interviews (26) and focus groups (4) with cross-sectoral participants, monthly interviews with team leads, and monthly observations of key team meetings with a subsection of three teams. Participants included senior managers from hospitals, home care and community organizations, physicians, care coordinators, patients, caregivers and OHT staff members. We also conducted a document review of relevant system-level guidance and OHT-level program proposals.
Results: The MOH sought to enact change through three key levers: First, after a competitive bidding process, a single home care service provider organization (SPO) was selected to service all home care patients within a specific jurisdiction at a capitated rate, replacing the multiple service providers and fee-for-service structure that previously existed. Secondly, the care coordinator would be accountable not only to the provincial home care organization but also to the OHT, a move that also encouraged the care coordinator to be embedded within a care team and other team members to take on limited care coordination tasks. Third, team members would have access to an information sharing platform previously accessible only to the home care sector. In addition, OHTs themselves proposed changes related to the embedding of care coordinators in primary care teams and neighbourhood settings, and new roles to bridge coordination responsibilities. While OHT stakeholders largely welcomed these changes, their concerns were threefold: First, the SPO procurement process culminated only shortly before anticipated program implementation; this was particularly challenging for some teams where an SPO unfamiliar with the area was successful. Secondly, the provincial home care coordinator agency (alongside its associated labour union) was seen as an unwilling participant that pushed back on efforts to tweak the care coordinator role to enable effective teamwork. Third, the provincial impetus to standardize care coordination approaches across projects (aimed at levelling patient experience and facilitating evaluation) was seen as discouraging local innovation.
Implications: The audience for these findings includes jurisdictions seeking to learn about the promise and limits of innovative approaches to care coordination in the home care sector. These findings indicate the importance of a locally relevant procurement process, the engagement and partnership of all sectors and open conversations in the absence of that engagement, in order to arrive at common ground.