aohc.org Oral health care programs in Ontario: Let’s move beyond band-aid solutions One in six Canadians avoid going to the dentist because they cannot afford it. AOHC believes that to truly eliminate barriers to health our longterm goal should be to ensure that oral health care is covered under OHIP so that everyone, no matter what their income, has access to quality dental care. AOHC’s strategic plan for 2012-2015 commits our organization to promoting an affordable, accessible oral healthcare program for all low-income children and adults in partnership with our members, the Ontario Oral Health Alliance and others. As part of this work AOHC has been conducting a member survey to find out which members offer oral health programs and what the challenges and successes are to date. We are particularly interested in the Healthy Smiles Ontario (HSO) program introduced in 2010 which provides preventive and early treatment dental services to children under 18. They are eligible if their adjusted family net income is under $20,000 and the family is not receiving social assistance or dental insurance coverage. Of the 36 AOHC members providing dental services, 25 community health centres and one community family health team are now participating in Healthy Smiles Ontario with funding flowed from public health units. No Aboriginal health access centres were approved for delivery despite strong interest in the program. But HSO is still a band-aid approach added to a patchwork of government programs. Feedback from our survey found that the new program is experiencing teething problems: The income eligibility criteria are too low leaving many low income children without access; There is lengthy paperwork to be completed; Most CHCs did not receive operational funding for program delivery and many are experiencing financial difficulties;
The program does not address oral health needs for the rest of the family. Our first priority is to ensure that our member centres with oral health programs are appropriately funded to deliver them. We have been meeting with MOHLTC staff to press this point.
Healthy Smiles Ontario’s teething problems include eligibility criteria set so low that many low‐income children don’t qualify But we want to go further. At an April panel on oral health at the Ontario Public Health Convention, AOHC executive director Adrianna Tetley called on the Ontario government to replace the current patchwork with a unified oral health program for all Ontarians. The first logical step is to combine Healthy Smiles Ontario and the Children in Need of Treatment (CINOT) program into one program, with a higher income eligibility level so more low income children can get the oral health services they need. AOHC is currently working with the Toronto Public Health, Dental and Oral Health Services and the Ontario Association of Public Health Dentistry to flesh out this proposal and advocate for change to the Ministry of Health and Long-term Care.
For further information on AOHC’s advocacy work on oral health please contact Jacquie Maund, Policy and Government Relations Lead, at jacquie@aohc.org.
ACTION: Postcards are coming to your centre Our survey also confirmed that there is a huge need among low income adults for oral health care. To help build public support for expanding provincial programs to include adults who cannot afford emergency dental services, AOHC is partnering with the Ontario Oral Health Alliance in a postcard campaign directed at local MPPs. AOHC members will soon receive printed postcards which we would like you to get signed over the summer. The plan is for the local AOHC member contact to collect as many signed postcards as possible and then set up a meeting with your local MPP for the fall to deliver them, discuss the issue, and seek his/her commitment to support this campaign.
Group insurance plan delivers costs savings and a more integrated approach Earlier this year AOHC and the Ontario Federation of Community Mental Health and Addiction Programs (OFCMAP) entered into a new agreement that will deliver cost savings for member centres and better group benefits for the staff of those member centres. The agreement has led to a new community health benefits and insurance plan. Altogether, over 114 organizations insuring over 2,900 employees will benefit from the new merged plan, resulting in reduced pricing for benefits covering health and dental plans, as well as life and long-term disability insurance. Green Shield, the current health and dental benefits carrier for both AOHC and OFCMAP will be retained. A life and long-term disability insurance carrier is being selected through an open procurement process. The merged plan is one of the early success stories of Community Health Ontario (CHO), a recently formed alliance of AOHC, OFCMAP and the Ontario Community Support Association. One of CHO’s key commitments is to explore integration opportunities for the three associations, while at the same time ensuring each association continues to fulfill its own unique purpose. “Improved integration is a major goal in Ontario’s health system and Community Health Ontario is committed to lead by example,” says AOHC executive director Adrianna Tetley, noting that the new merged plan will enable cost savings for both associations as well as its members. “In a time of fiscal restraint it’s so important to find efficiencies and reduce administrative fees while at the same time being able to provide an even more comprehensive benefit package for our members,” says OFCMAP executive director David Kelley. “In this case, savings from the merged plan can be redirected back into critically important health services in the community.”
Other organizations interested in joining the new plan should contact the new plan are welcome to contact Adrianna Tetley at AOHC: Adrianna@aohc.org or David Kelly at OFCMAP: dkelly@ofcmhap.on.ca. Or you can make direct contact with Stevenson and Hunt Insurance Brokers Ltd. Waterloo office at 1 888 772 0972. You can contact Susan Healey at ext 5121 (susan.healey@sthunt.com) and Alan Schreiber at ext 5120 (al.schreiber@sthunt.com) Over the coming years, AOHC and OFCMAP intend to grow the merged plan. Other organizations in the community health sector are invited to join. This will be a particularly attractive option for smaller organizations with just a few employees who generally cannot afford comprehensive coverage. The more organizations that join the plan, the better the pricing for all.
Congratulations to all the member centres who are celebrating grand openings. In June, those were: Emery–Keelesdale Nurse Practitioner-Led Clinic Walpole Island CHC, a satellite of Chatham-Kent CHC CSC Chigamik CHC’s access point for those living in Christian Island, Lafontaine and Tiny Township
Is your organization holding an event or celebration in your community? If so, we want to know about it! Please send details to Stephanie Hemmerick, AOHC newly-hired member services liaison, at stephanie@aohc.org. SUMMER 2012
And congratulations to members who are celebrating milestone anniversaries: Somerset West CHC on its 40th anniversary (and street party) Langs’ 30th anniversary. Mission accomplished indeed, on your new facility. North Hamilton CHC on its 25th anniversary East End CHC also marking its 25th anniversary NorWest CHC on turning 20, and Noojmowin Teg Health Access Centre for turning 15
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It’s time to implement the full vision of medicare A full vision of medicare underlies AOHC’s own vision of the best possible health and well-being for everyone living in Ontario. So even as we celebrate the 50th anniversary of the implementation of medicare, we say it’s time to move forward with real solutions that work for all Ontarians. The good news: scores of these solutions are already underway in our public not-forprofit health care system. But they are not happening widely enough. Our challenge: to break down barriers so we can start spreading these solutions right across the province enabling all Ontarians to enjoy their benefits.
In our community. With our community.
Read more at aohc.org
Community Health Week October 1‐5
Dans la communauté. Avec la communauté.
Materials available in August.
North Shore Tribal Council visits Nuka home
Fourteen members of the North Shore Tribal Council travelled to Alaska’s Southcentral Foundation in May to learn more about the reknowned Nuka model of care. In the middle in blue is council health director Gloria Daybutch. Peeking over the back is AOHC executive director Adrianna Tetley, who accompanied the group. And second from the left is Southcentral’s CEO Katherine Gottlieb with her grandson, who hosted the group with NUKA institute coordinator Erica Srisaneha, (second from right). SUMMER 2012
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New research spotlights need for more rigorous primary health care planning Ontario needs a more rigorous approach to primary health care planning, according to lead researchers who presented their findings at AOHC‘s recent June conference. During a plenary session on system planning, Dr. Rick Glazier, from the Institute for Clinical Evaluative Sciences, and Dr. Kiernan Moore, from Queen’s University, both highlighted that a largely unplanned and unaccountable primary care system has led to many communities encountering significant barriers accessing the services they need. During his presentation to conference delegates Dr. Glazier spoke of a “mismatch” between the performances of the wellresourced models and the needs of populations whose health is most at risk. He cited a recent comparison of models conducted by ICES which revealed a wide variance in how the province serves poorer and sicker populations. A case in point: physician-led capitation team models, which family health teams (FHTs) belong to, have received the largest amount of new resources and are serving relatively advantaged groups. Even so, those served by FHTs have higher than expected use of hospital emergency departments. Meanwhile, Ontario’s community health centres and Aboriginal health access centres, currently resourced to serve less than four per cent of the population, are serving lower-income populations in poorer health but do a significantly better job than other models keeping people out of hospital emergency departments. Dr. Glazier expressed optimism that the increasing ability of researchers to gather data on the performance of various models opens the door to development of a better mix of models to serve populations with complex needs. Research presented by Dr.
Kiernan Moore reinforced his case. In the South East LHIN, Dr. Moore’s demographic analysis shows that healthier and wealthier areas enjoy relatively good access to services, while the most deprived areas suffer from the worst. Significantly, Moore’s research also shows that populations with poor primary care access have significantly higher rates of hospital and emergency department use.
2012 PRIMARY HEALTHCARE CONFERENCE Moore called for a major shift in approach arguing family doctors should no longer be able to work as solo practitioners, nor should they be allowed to set up practices wherever they want. “Long gone are the days of solo practitioners. That has to end,” he told conference delegates. AOHC echoes growing calls for more needs-based primary healthcare planning and hopes to meet with the LHINs soon to present detailed province-wide demographic analysis which shows which parts of the province most urgently need the services from interprofessional teams equipped to address the social determinants of health. “Now that primary care planning is moving to the LHINs, we have an opportunity to move forward with a new vision – a vision that involves access not only to physicians but also to other kinds of providers who help keep people well,” says AOHC executive director Adrianna Tetley. “We have to do much more than tinker around the edges. We’re looking to the LHINs to create a new vision, and then move forward with a transition plan.”
Cathy Fooks (left), CEO of the Change Foundation, moderates an conference panel on system planning for people-centred care. To her right are Susan Pigott, vice president of the Centre for Addiction and Mental Health; AOHC executive director Adrianna Tetley; Paul Huras, CEO of the South-east Local Health Integration Network: and researchers Dr. Kieran Moore of Queen’s University and Dr. Rick Glazier of the Institute of Clinical Evaluative Studies.
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ANNUAL GENERAL MEETING
Excellent Care for All: Leading the way forward At AOHC’s primary care conference in June, there were a number of workshops that explored the Excellent Care for All Act (ECFAA) and how AOHC members have the opportunity to accelerate their quality journey before the Act takes effect. ECFAA legislation includes what is currently required for hospitals and may be required when the Act is applied to all of primary care in the coming years. While there is no fixed date for when ECFAA will be regulated for communitygoverned primary health care centres, the race is on and rumour has it that annual quality improvement plans will be mandatory by 2013. CHCs are in an ideal position to fasttrack the most challenging components of the quality agenda , was the key message of workshop presenters Paula BlackstienHirsch and Cathy Fooks from the Change Foundation.
Those components include: Developing the knowledge and skill at the board, so that members know what is required, can identify and oversee quality priorities, and understand the right questions to ask of management; Developing the knowledge and skill required of senior leaders to lead the agenda; Engaging and motivating staff, and providing them with quality improvement capability to engage in meaningful and sustainable change; Creating a culture of continuous improvement, developing a focused set of indicators, and holding the organization accountable. AOHC is presenting the professional learning event “Governance Leading Change” in the fall for member-centre boards that includes the theme of governance roles in quality improvement.
Does your board have a quality committee? The Excellent Care for All Act requires hospital boards to do so. Here are the responses of 60 participants at the June 7 workshop.
For more information visit www.aohc.org/upcomingevents
A dialogue to conƟnue at each centre and throughout the province aohc.org/conference for
Speaker presenta ons Workshop presenta ons Digital presenta on gallery (online poster sessions) Photos coming soon
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Full scope of practice within 3 years On June 28, the Association of Ontario Health Centres (AOHC) announced that its members — over 120 community-governed primary health care centres throughout the province — have set a goal to ensure all their registered nurses, registered practical nurses and all other health providers are practising to their full scope within three years. By meeting this goal, over 500,000 served by the centres will receive a higher quality of care from interprofessional teams and the province will also get better value for healthcare dollars, stated AOHC. “This goal is designed to take a good thing – interprofessional health teams – and make them even better. We intend to play a lead role ensuring people and communities receive the right services provided by the right mix of health providers,” said AOHC executive director Adrianna Tetley.
AOHC adopts bold vision for the future
Tetley pointed to recent research from the Institute of Clinical Evaluative Sciences and the Élisabeth Bruyère Institute which demonstrates that Ontario’s community health centres deliver a superior quality of care compared to other models. “Our focus delivering services using interprofessional teams could be a key factor in the superior quality of care community health centres deliver. So we intend to strengthen those teams even further by ensuring each and every provider is maximizing their full potential,” she said. The association’s announcement followed the release of the Registered Nurses’ Association of Ontario (RNAO)'s groundbreaking report: Primary Solutions for Primary Care: Maximizing and Expanding the Role of the Primary Care Nurse in Ontario. The RNAO report was prepared by a task force of which AOHC was a part. It contains 20 recommendations calling on a number of stakeholders, including government, regulators and primary care organizations, to maximize and expand the role of 4,285 Registered Nurses and Registered Practical Nurses working in Ontario’s primary care system. Fully implementing the Task Force’s recommendations will increase access to primary care for Ontarians, improve the delivery of quality, person-centred care and will support health system cost effectiveness. Read more at aohc.org
AOHC has set a bold course for the future with adoption of a new vision statement: the
best possible health and well-being for everyone living in Ontario. The new vision was formally adopted at the association’s 30th annual general meeting on June 6, along with an accompanying new mission statement and three-year strategic plan. You’ll find a two-page attachment at the end of this issue of Synergy that illustrates the plan. Health equity is a cross-cutting principle in every part of the new mission and plan. Another cross-cutting theme is the concept of people and community-centredness. “On an association’s thirtieth birthday, what better time to reaffirm and refresh our founding principles,” says AOHC president Jocelyne Maxwell. “Many thanks to all the AOHC members who provided feedback during our strategic planning process. It’s their insight and ideas that have inspired the new directions we are taking.” SUMMER 2012
AOHC’s current and past presidents honour executive director Adrianna Tetley for her service and guidance to the organization — explaining this is to thank her and to encourage her to keep going. Emotional, in response, Adrianna said, ‘I’ve still got energy for this!” From left, France Gelinas, Simone Atunga, Adrianna Tetley, Denise Brooks, Jocelyne Maxwell ASSOCIATION OF ONTARIO HEALTH CENTRES
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ANNUAL GENERAL MEETING
Be it resolved that … and the motion carries With debate and deliberation, the AOHC membership adopted nine separate resolutions at this year’s Annual General Meeting, held on June 6 in Toronto.
In regards to AOHC governance:
Updated vision and mission statements Bylaw changes including (1) A formal definition of community governance, (2) updated criteria for full members, and (3) qualifications of AOHC directors The organization’s strategic directions for 2012-15 (see the final two pages of this issue for the highlights)
Motions in support of the following health policy initiatives:
The adoption of a Health Equity Charter for the association and others Championing a renewed Federal-Provincial Health Accord that includes, among other criteria, a plan for expansion of medicare to include oral health and pharmacare coverage Provincial and federal pharmacare strategies And an emergency resolution that calls for the federal government to suspend cuts to temporary health coverage for refugees, the IFH program. The implementation of these resolutions will unfold over the coming months. Contact Sophie Bart, AOHC’s manager of member services, for details at sophie@aohc.org.
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VISION The best possible health and well-being for everyone living in Ontario.
• A future without systemic barriers
that prevent people from reaching their full health potential, a future in which everyone can make the choices that allow them to live a fulfilling life.
• A
future in which individuals, families and communities are served by, and are able to actively participate in, trusted healthcare systems that respond to people’s and communities’ needs in coordinated and comprehensive ways.
ASSOCIATION OF ONTARIO HEALTH CENTRES
strategic plan 2012-2015
• A future in which people share
responsibility with their health providers for their health and wellbeing.
MISSION As the voice of communitygoverned primary health care in Ontario, AOHC works
• to
promote public policy that supports health and well-being, and that emphasizes health promotion and illness prevention through a strong focus on the social determinants of health.
• to advocate for eliminating systemic barriers to health and to champion health equity.
• to
promote people- and com munity-centred innovations in the primary healthcare system that improve health and well-being and support healthcare sustainability.
• to support our member centres
to continuously improve the quality and efficiency of their services and to advocate for the resources they need to deliver high-quality care.
• to
advocate for the protection and improvement of medicare, ensuring that reforms to our publicly funded system focus on keeping people well and benefit everyone.
The overriding guideposts for AOHC continue to be a vision of everyone having the best possible health and well-being, and a healthcare system in which everyone matters. Our commitment to anti-oppression and achieving health equity for all remains central to this plan, as do the values reflected in the community health centre model of care. AOHC will advance health equity and healthy public policy by advocating for the elimination of systemic barriers to health. To improve health outcomes and support healthcare sustainability, we will champion the transformation of primary health care so that it realizes its full potential as the foundation of the healthcare system. We will work with our partners to ensure that all residents of Ontario, especially those who face systemic barriers, can access comprehensive health and social services as needed. We will support our member centres to be leaders in this primary healthcare transformation, while ensuring that people whose health is most at risk or who have faced barriers to accessing services can get the services they need. We will lead and participate in research initiatives that evaluate the effectiveness of community-governed primary health care in improving health outcomes, serving people with complex health needs and contributing to the sustainability of the healthcare system. Finally, we will strengthen AOHC’s organizational capacity to deliver on the goals and objectives associated with this strategic plan.
AOHC
970 Lawrence Ave W, Suite 500, Toronto, ON M6A 3B6 T: 416-236-2539 E: info@aohc.org www.aohc.org
ASSOCIATION OF ONTARIO HEALTH CENTRES
strategic directions L •
H E QUITY
QUALIT HEAL Y PR TH I C
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CO CO E OR M P R E H E N SIV ICES DIN ATE D SERV • •
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People and Community Centred
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Healthy Public Policy and the Elimination of Systemic Barriers
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AOHC will advocate for the elimination of systemic barriers to health through the development of healthy public policy. This includes equitable allocation of appropriate resources for populations whose health is most at risk or that face barriers accessing services.
Quality Primary Health Care AOHC will champion people- and community-centred primary health care that fulfills its mandate as the foundation of the healthcare system.
Comprehensive, Coordinated Services AOHC will promote comprehensive, coordinated health and social services.
enabling directions Supporting Member Centres AOHC will support member centres to build capacity to continuously improve the quality and efficiency of their services. We will also ensure that member centres are appropriately resourced to fulfill their mandate of improving the health of individuals, families and communities.
Supporting Members Research and Evaluation Strengthening AOHC
Community Primary Healthcare Research and Evaluation
A Strengthened AOHC
AOHC will lead and participate in data-driven, evidence-informed research and evaluation initiatives to document and assess the impact of communitygoverned primary health care on health outcomes and the sustainability of the healthcare system.
AOHC will ensure it is sufficiently resourced, aligned with partners and positioned in the larger health and political environment to be an effective leader in community-governed primary health care in Ontario.
Ontario’s voice for community-governed primary health care
FPO