Normand Latagne & Alexandra Constant, Ministry of Health and Social Services of Quebec: Alternative...
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Transcript of Normand Latagne & Alexandra Constant, Ministry of Health and Social Services of Quebec: Alternative...
Ministère de la Santé et des Services sociauxAgence de la Santé et de Services Sociaux de Montréal
Alternative funding initiatives for seniors inAlternative funding initiatives for seniors in Québec
Presented by :Normand Lantagne, Head of resources Allocation serviceNormand Lantagne, Head of resources Allocation service
Ministry of health and Social services of Québec
Alexandra Constant, Performance & Funding Policy Coordinator M t l H lth d S i l S i A
January 30, 2014
Montreal Health and Social Services Agency
Plan
Elderly funding initiatives in Montreal
Th i di A t iThe impending Autonomy insurance program
Moving forward
2
A portrait of Eldercare in Montreal (2012‐2013)M t l ll di h lth d i l i
2,5%
Montreal overall spending on health and social services was $6.7 billion in 2012‐2013
13 3% f t t l di6,9%
8,7%
3,5%2,2%
1,2% 8,8% 13.3% of total spending occurred in the Support Program for the Autonomy
0,4%
4,3%
of Senior Citizens.
The program’s per‐capita
13,3%
41,3%
891 M$expenditure stood at $449.
The inflation‐adjusted
6,8%
The inflation adjusted increase in spending from the year 2011‐2012 was 1 59%
31.59%.
A Portrait of Eldercare in Montreal (2012‐2013)
Long-term care centers use up the biggest portion of eldercare funds:
The Support for the Autonomy of Senior Citizens Program
890 679 980 $
‐ Intermdiate resources (8%)‐ Home Care Services (16%)
‐ Long‐Term Care Centers (59%)
‐ Other services (17%) ‐ Home Care Services (16%)
Work is underway to transition long term care center seniorsWork is underway to transition long-term care center seniors through to home care. This requires proper management and intensification of specialized services to accommodate
4seniors with high needs.
The Current Funding Mechanism: from the Montreal Agency to the Facilities
Eldercare funding is part of the global budget given to facilities in support of their health and social programs, beginning of every fiscal yearbeginning of every fiscal year.Shortcomings:
Suspected inequities across health facilities Facilities have the liberty of managing their own budget allocation as no amount is ever “tagged” to a specific program (eldercare included). This means that money use
b d dcan NOT be restricted to spending on senior care.Inability to investigate whether investments in eldercare are used to finance corresponding program activities.Absence of incentives to improve performance.
5
The Prognosis
As an initial step toward dealing with the deficiencies of the global budget, the Montreal Agency kicked off a multi‐phase project analyzing alternative funding mechanisms that could be p oject a a y g a te at e u d g ec a s s t at cou d beapplied to each of the nine service programs.
Surtherland, J. and al. Ottawa; 2013. Funding Health and Social Care in Montréal, Québec: A Review of the Methods and the P t ti l R l f I ti C di F d ti f H lthPotential Role of Incentives. Canadian Foundation for Healthcare Improvement.Sutherland, J. and al. Ottawa; 2012. Reviewing the Potential Roles of Financial Incentives for Funding Healthcare in Canada. Canadian gFoundation for Healthcare Improvement.
Results for the Support of the Autonomy of Senior citizens program : − Montreal lacks the fundamental tools enabling movement toward an alternative funding method in the short horizon.
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The Prognosis
Results for the Support of the Autonomy of Senior citizens program : − Implementing standardized clinical assessment instruments in order to differentiate resident case mix.mix.
− Understanding the allocation of financial, clinical and human resources within the distinct institutions of the
f ilisame facility.− Translating the needs of similar patients to financial requirements warranting an equitable distribution ofrequirements warranting an equitable distribution of funds.
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Incremental Change is Underway
30 000 000 $
Senior Home Care – Money Utilization Issues
20 000 000 $
25 000 000 $ Spread = $ 5.9 MThe The MtlMtl Agency has Agency has given the directive given the directive
15 000 000 $
20 000 000 $ to firmly upholdto firmly upholdand closely monitor and closely monitor the utilization of the utilization of budgets destinedbudgets destined
5 000 000 $
10 000 000 $
budgets destined budgets destined for senior home for senior home
carecare
‐ $ Variation in Home Care
Investments from 07/08 to 11/12
Variation in Home CareExpenditure
from 07/08 to 11/12
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from 07/08 to 11/12 from 07/08 to 11/12
Incremental Change is Underway
The Montreal Agency devised an alternative home care
Senior Home Care – Equity Issues
The Montreal Agency devised an alternative home care funding method based on local population needs. The method controlled for inter-facility differences in resource
d t d tili tiendowment and money utilisation.
The process of formulating the payment method provided p g p y pevidence for the presence of inequities across local facilities.
To allocate its latest home care new budget ($10.5M), the Agency aimed at marginally restoring equity.
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Eldercare program: Short‐Term Solutions
In the aim of realizing the most urgent needs in senior home care, the Montreal Agency launched a multi‐step process comprising the following short‐term instruments:
the implementation of an evaluation tool used to stratify d h d l l fpatients according to their estimated level of resource
consumption (Iso‐Smaf).
the promotion of a more equitable payment system that isthe promotion of a more equitable payment system that is based on the integration of various financial incentives like pay‐for‐performance budgets that could be used in parallel with the global funds.
reduce the number of beds used by ALC patients via structural changes in practice and financial penaltiesstructural changes in practice and financial penalties.
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Partnering with the Ministry of Health
The Montreal Agency seeks to align any future plan of action concerning eldercare funding with that of the Ministry (enhancement of the eldercare environment; patient evaluation directives; and costing procedures).
The Agency acknowledges that the willingness to take the next step away from global budgets necessitates as athe next step away from global budgets necessitates, as a first step, a proper assessment of senior home care needs.
12
Th i di A t iThe impending Autonomy insurance program – Aging population problem
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Th i di A t iThe impending Autonomy insurance program - Aging population problem
50 0%
60,0%
Taux d'incapacité modérée et grave selon l'âge population de 15 et plus, Québec, 2010‐2011
30,0%
40,0%
50,0%
10,0%
20,0%
0,0%
15‐64 ans 65‐74 ans 75‐84 ans 85 ans +
Modérée Grave
14
Rate of moderate and severe disability by agePopulation aged 15 years and over, Québec 2010‐2011
Th i di A t IThe impending Autonomy Insurance Program - Aging population problem
• What the population wants: to stay in their ownhomes
66% of Quebecers would like priority to be given– 66% of Quebecers would like priority to be givento home care, services and rehabilitation
– 72% of Quebecers rely on the public system forhome care and services
Source: Canadian Medical Association, 2013. 13th Annual NationalReport Card on Health Care
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Th i di A t IThe impending Autonomy Insurance Program - Aging population problem
• Issues– The health and social services network must
promote autonomy by allowing people to stay inpromote autonomy by allowing people to stay intheir living environment for as long as possible
– Service organization and funding for long-termcare and services must also be reviewed to meetthe growing demands of those experiencing aloss of autonomyloss of autonomy
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Th i di A t IThe impending Autonomy Insurance Program – Objectives and description
M i bj ti• Main objectives– To promote the provision of services where people
live (focus on home care services)T t t f di f th i id d– To protect funding for the services provided
• Autonomy insurance gives freedom of choice back topeople experiencing a loss of autonomy
Wh t li– Where to live– Type of services they receive– Service provider
• Autonomy insurance involves implementing equitableinterregional service coverage and fee schedules
17
Th i di A t IThe impending Autonomy Insurance Program – Objectives and description
• Clientele of the program– Adults aged 18 years and over suffering from a
loss of functional autonomy who require longloss of functional autonomy who require long-term care and services
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Th i di A t IThe impending Autonomy Insurance Program – Objectives and description
S i id d• Services provided– Basic professional services
• nursing, nutrition services, psychosocial services,nursing, nutrition services, psychosocial services, rehabilitation services (physiotherapy and occupational therapy)
– Assistance with activities of daily living (ADL)y g ( )• Eating, washing, dressing
– Instrumental activities of daily living (IADL)• Housekeeping laundry meal preparation• Housekeeping, laundry, meal preparation
– Services for family caregivers(presence/monitoring, relief…)
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Th i di A t IThe impending Autonomy Insurance Program – Objectives and description• Service providersService providers
Assessment of the person’s situationService planning Execution of the service plan
*p
Coordination of servicesQuality of the services provided
Professional care and services
• Private businesses (e.g., seniors’ residences)‐ Basic nursing care
Contractual agreements
‐ Assistance with ADL‐ Assistance with IADL
• Domestic help social economy business (Entreprise d’économie sociale en aide domestique – EÉSAD): assistance with ADL and
Approved
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IADL• Community or other types of organizations: assistance with IADL
* Centre de santé de de services sociaux (CSSS) : Health and social services centre (HSSC)
Th i di A t IThe impending Autonomy Insurance Program – Objectives and description
A t f d F ti l A t• Assessment of needs: Functional AutonomyMeasurement System (Système de mesure del’autonomie fonctionnelle – SMAF)
Thi t– This system• measures functional disability in relation to everyday
activities• classifies subjects with similar disabilities that generate• classifies subjects with similar disabilities that generate
similar costs and services into 14 Iso-SMAF profiles – The Iso-SMAF profile is a clinical and management
tool used in the organization and planning of servicestool used in the organization and planning of servicesand the allocation of resources. It determines thetype of services and the number of hours of care andservices
21
Th i di A t iThe impending Autonomy insurance program – Objectives and description• Iso SMAF profiles• Iso-SMAF profiles
Overview of clienteles:Profiles 1, 2, 3: IADL disabilities
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Profiles 4, 6, 9: Mobility problems dominantProfiles 5, 7, 8, 10: Mental problems dominant Profiles 11, 12: Require assistance with mobilityProfiles 13, 14: Bedridden and dependent for ADL
Th i di A t IThe impending Autonomy Insurance Program – Objectives and description• Use of the Functional Autonomy Measurement System aroundUse of the Functional Autonomy Measurement System around
the world:– This system is available in eight languages: French, English,
Spanish, Dutch, Catalan, German, Portugese and EstonianUse– Use
• Québec (health and social services network and private clinics)• France (49 departments and in MAIA - Maisons pour l’autonomie et
l’intégration des malades Alzheimer [Centres for the autonomy and integration of Alzheimer’s patients])g p ])
• Belgium (BAP – budget d’assistance personnelle [Personalassistance program])
• Ontario (University of Toronto and University of British Columbia)• New Brunswick• Switzerland (1 canton)• Australia (1 region)• International researchers
– Recognized as the “gold” standard in researchg g
23
Th i di A t IThe impending Autonomy Insurance Program – Financial issue
• Autonomy fund
$ PD
$ SEA$ ID‐PDD
+ $100M/year (2012‐2017) in home care services+ Programme d’exonération financière pour soutien à domicile (PEFSAD) [Financial Assistance Program fordomicile (PEFSAD) [Financial Assistance Program for Domestic Help Services]
PD: Physical disabilityID PPD: Intellectual disability and Pervasive Development Disorder
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ID‐PPD: Intellectual disability and Pervasive Development DisorderSAPA: Support for elderly autonomy
Th i di A t IThe impending Autonomy Insurance Program – Financial issue
• Autonomy Support Benefit (ASB)– Based on the user’s needs profile
Modified depending on:– Modified depending on:• income (recipient’s ability to pay)• available funding
• The user chooses the service providers
25
The impending Autonomy InsuranceThe impending Autonomy Insurance Program – Financial issue• Autonomy Support Benefit (ASB)Autonomy Support Benefit (ASB)
$ ASBNeeds profileAssessmentHSSC
$ ASB (14 Iso‐SMAFprofiles)
OEMC‐SMAF
Household incomeCase manager
(or key practitioner)
DisabilitiesResources available
Handicaps
Service plan
H f i U t ib ti
C t t ith iHSSC i
Hours of service Monetary allowance
User contribution
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Contracts with service providers
HSSC services
OEMC: Outil d’évaluation multi‐clientèle [Multiclientele assessment tool]
M i f d Th i l t tiMoving forward – The implementation process
• 2014-2015– Implementation of clinical, information
technology and financial tools required totechnology and financial tools required tomanage the ASB
– Creation of centralized databases to manage theprogram
– Modifications in the allocation of resources inorder to protect the autonomy support budgetorder to protect the autonomy support budget
– Development of an ASB benefit grid
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M i f d Th i l t tiMoving forward – The implementation process• 2015 2016• 2015-2016
– Implementation of the ASB: the benefit is used toestablish the home care services plan
– Target clienteles• Older adults who are experiencing a loss of autonomy• Adults with a physical disabilityAdults with a physical disability• Adults with an intellectual disability or Pervasive
Development Disorder– Priority given to home care services and gradualPriority given to home care services and gradual
transition to equivalent funding in all livingenvironments
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M i f d Li k ith th ffMoving forward – Linkages with the offer of service and funding policy in home care
• Support for people experiencing a loss of autonomyrelies too heavily on residential care
• Funding must gradually prompt a shift toward home• Funding must gradually prompt a shift toward homecare services
• It must not be more advantageous financially to optfor residential care
• Sufficient home care services must be provided toallow people even those with significant autonomyallow people, even those with significant autonomysupport needs, to stay in their own homes
29
M i f d Li k ith th ffMoving forward – Linkages with the offer of service and funding policy in home care
S i l b i ill l k l i idi• Social economy businesses will play a key role in providingsupport services for activities of daily living andinstrumental activities of daily living
• Health and social services centres will have primaryresponsibility for assessing clients, planning andcoordinating services, providing professional services andquality control
• Ultimately, the ASB will have to cover all support, includingresidential care, ensuring similar funding is allocated to thedifferent types of resources for similar needs, therebygiving the user freedom of choice
30
Questions and comments?
31