2014-17 Multi-Sector Service Accountability Agreement (M-SAA)Template Overview

M-SAA Information Session February 2014

What is an M-SAA?Core lever for HSP accountability and performance management

• A tool to bring all the various contractual agreements between community HSPs and the LHINs into one document

• Required under LHSIA and Ministry-LHIN Performance Agreement (MLPA)

• A vehicle to delineate accountabilities and performance expectations

• A mechanism to clarify that the Health Service Providers will be responsible for performance as well as planning and integration towards the development of a health system

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Pan-LHIN Development, Local ExecutionDeveloping provincial templates for local execution

• Consistent template agreement for all community sector HSPs developed through comprehensive consultation with HSP associations and member representatives (membership listed in Appendix 1)

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• Schedules for each sub-sector (CCAC, CHC, MH&A and CSS) developed through consultation with sub-sectors

• Individual LHINs negotiate performance indicator targets with each HSP in alignment with pan-LHIN guidelines

2014-17 M-SAA ApproachLHIN Negotiating Team, Mandate and Processes

• In May 2013, Louise Paquette (CEO, NE LHIN) was confirmed as Chair of the M-SAA Advisory Committee and Scott McLeod (CEO, CW LHIN) was confirmed as Vice-Chair.

• The mandate and scope of authority of the negotiating team was established through dialogue with the LHIN CEOs and was confirmed as follows:

• Working with LHIN Legal Services, identify opportunities to revise language that either requires updating or would benefit from greater clarity

• Working with community sector representatives, invite and review sector feedback• Finalize a 3-year M-SAA by the end of 2013 to enable local execution by March 31, 2014.

• Each and every suggestion submitted by the Sector and MOHLTC was reviewed by LHIN Legal and revisions were incorporated where appropriate.

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M-SAA Development PrinciplesEnabling close ongoing collaboration with the Community Sector

• The M-SAA Advisory Committee is co-chaired by Louise Paquette (CEO North East LHIN) and Scott McLeod (CEO Central West LHIN) and brings together senior executives from M-SAA sector associations, community HSPs and the LHINs to provide a central forum for enabling dialogue on provincial M-SAA issues

• The Committee is guided by the following principles:

• The process is undertaken with a spirit of trust and collaboration among the province’s community HSPs, sector associations and the LHINs.

• The M-SAA will align with provincial health system priorities and be consistent with MOHLTC policy, legislation and regulations.

• The M-SAA will strive to streamline processes, minimize administrative burden and provide clarity.

• See Appendix 1 for Committee membership

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M-SAA StructureComprehensive Consultation through Multiple Tables

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M-SAA INDICATOR SUPPORT: HEALTH SYSTEM INDICATOR INITIATIVE

M-SAA LEGAL COUNSEL SUPPORT: LHIN LEGAL SERVICES BRANCH

M-SAA SECRETARIAT SUPPORT: LHIN COLLABORATIVE

LOCAL M-SAA IMPLEMENTATION: LHIN M-SAA LEADS

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Sector Organization Individual, Title

LHIN NE LHIN Louise Paquette, CEO

LHIN CW LHIN Scott McLeod, CEO

LHIN NE LHIN Kate Fyfe, Senior Director

LHIN CW LHIN Brock Hovey, Senior Director

LHIN CW LHIN Neil McIntosh, Director

CHC AOHC Adrianna Tetley, Executive Director

CHC Davenport Perth Neighbourhood CHC

Kim Fraser, Executive Director

CSS OCSA David Hughes, Manager

CSS CANES Community Care Gord Gunning, CEO

M-SAA Advisory Committee Membership

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Sector Organization Individual, Title

CMH&A Addictions & Mental Health Ontario

David Kelly, Executive Director

CMH&A CMHA Ontario Camille Quenneville, CEO

CMH&A CMHA Toronto Steve Lurie, Executive Director

CCAC OACCAC Sharon Baker, COO

CCAC CE CCAC Don Ford, CEO

LTC OANHSS Jeff Graham, Director, Public Policy

LTC City of Toronto Reg Paul, General Manager, LTC Homes & Services

LTC OLTCA Paula Neves, Director of Health Planning and Research

LTC Extendicare Inc. Christina McKey, VP, Eastern Operations

M-SAA Advisory Committee Membership continued

LHIN/Sector ResponsibilitiesAdvisory Committee and Work Group Mandates

M-SAA Advisory CommitteeEstablished to provide advice to the LHIN CEOs and support for the completion of the 2014-17 M-SAA template agreement and schedules in alignment with provincial strategic directions.

M-SAA Indicators Work Group•Established to support the M-SAA Advisory Committee. Based on direction from the LHIN CEOs, the Work Group is responsible for producing a series of documents and recommendations including a list of recommended M-SAA indicators, technical specifications, target setting guidelines and education materials.

M-SAA Planning & Schedules Work GroupEstablished to support the M-SAA Advisory Committee. Based on direction from the LHIN CEOs, the Work Group is responsible for producing a series of documents and tools including M-SAA Schedules, CAPS forms and planning submission guide and educational documents.

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LHIN/HSP Accountability RelationshipHow do the various CAPS/M-SAA components fit together?

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Community Accountability

Planning Submission(CAPS)

Multi-sector Service Accountability

Agreement(M-SAA)

Quarterly Reports

[Ontario Healthcare Report Standards (MIS)]

RemediationNegotiation,

Implementation of Consequences

Planning Commitment Measurement Adjustment

Negotiations/Consultations Negotiations

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• The Community Accountability Planning Submission (CAPS) is a three-year planning document that facilitates the negotiation of the M-SAAs between the LHIN and each HSP.

• In the absence of definitive funding targets, CAPS will be based on a planning assumption of 0% base adjustment. CAPS should be prepared to maintain service levels within the 0% planning assumption

• The M-SAA Schedules will be refreshed in the Fall of each year of the agreement to confirm the current year’s planning assumption and to update the agreement’s performance and explanatory indicators

• The provincial due date for the submission of a Board approved CAPS was November 15, 2013.

2014/17 CAPS ApproachWhat is a CAPS and how is it used?

LHIN/Sector ResponsibilitiesWhat are the responsibilities of the LHINs and the HSPs?

LHINs are responsible for:•Training and supporting HSPs through the CAPS and M-SAA processes•Negotiating performance targets within the context of a provincial framework•Monitoring the achievement of specific performance goals under the M-SAA and ongoing performance management

HSPs are responsible for:•Ensuring governance and operations that support high quality care•Promoting leading performance improvement approaches•Providing access to high quality health services and coordinated health care in an effective and efficient manner•Identifying integration opportunities and engaging the public and stakeholders in any planned service changes.

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Process for Finalizing New M-SAAAt a high level, how was the M-SAA developed and finalized?

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LHINs revised language in the 2011-14 M-SAA that required updating or would benefit from greater clarity as a draft 2014-17 M-SAA for sector feedback.

Three 3-hour M-SAA Advisory Committee meetings to review and discuss comments and suggestions on draft 2014-17 M-SAA.

175 sector comments received and individually addressed.

Committee endorsed 2014-17 M-SAA and Schedules on December 17, 2013.

Committee will continued to meet throughout the life of the agreement to advance M-SAA related priority issues.

Summary of Main ChangesWhat are the key changes between current and new M-SAA?

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REFERENCE DIFFERENCE REASON FOR CHANGEGeneral Update A variety of changes were made to correct

minor errors in references, use of defined terms, conformance and formatting.

To correct inadvertent errors and typographical errors.

1.1 Definitions Revised “Board” definition.

Added “controlling shareholder” definition.

Added “and volunteers” to definition of “HSP’s Personnel.”

Some long-term care homes have M-SAAs. The changes recognize that committees of management and boards of management are sometimes the ultimate authority, as opposed to boards of directors, for some long-term care homes.

“Controlling shareholder” appears in the definition for HSP’s Personnel. A definition was provided for “controlling shareholders” in order to be clear on who is captured. It is only relevant to HSPs that have controlling shareholders.

Volunteers and students are under the control of the HSP, no differently as regards the LHIN, than any of the HSP's paid staff or other agents.

3.2 Subcontracting Changed to enhance clarity. This provision clarifies that the HSP may hire others to provide the Services on the HSP’s behalf and states the terms on which they can do so.

3.4 e-Health/Information Technology Compliance

Changed to conform to the LHINs’ obligations under the MLPA.

LHSIA requires that LHINs provide their funding to HSPs in accordance with the LHIN’s accountability agreement with the Ministry (i.e. the MLPA). These changes are therefore required to conform to the LHINs’ obligations under the MLPA.

4.3 Appropriation Deleted the specific actions that a LHIN may take.

This provision reflects the Financial Administration Act and the change was made to eliminate any implied notion that the LHIN is limited in terms of what actions it can take in the event that there is no appropriation of funds.

Summary of Main Changes Continued

What are the key changes between current and new M-SAA?

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REFERENCE DIFFERENCE REASON FOR CHANGE4.6 Interest Adjusted language to incorporate flexibility. This section has been revised to incorporate flexibility into this requirement.

4.8 Procurement of Goods and Services

Changed to enhance clarity. The M-SAA requires HSPs to abide by all Applicable Law and Applicable Policy. To clarify the obligations, Section 4.8(a) has been revised to by inserting the phrase “that are applicable to the HSP pursuant to the BPSAA.”

6.1(c)(D) Multi-Year Planning Targets

Changed to reflect that LHINs typically consult with an HSP on changes multi-year planning targets.

Changes to multi-year planning targets should be addressed at the local LHIN level. HSPs should discuss this issue with their local LHIN and ask for the appropriate assumptions for planning purposes.

6.3(a)(ii) Planning and Integration Activity Pre-Proposal

Changed to enhance clarity such that the obligation captures the notion of physical change.

The LHINs are responsible for possible impacts to the health system of service changes and need to be made aware of changes to service delivery for health system planning purposes. In addition, this provision gives the LHIN the opportunity to review, evaluate and provide input into the HSP's plan, rather than being limited to stopping all or part of the plan.

8.1(d) Declaration of Compliance

Changed to once per year and revised due date.

Changed frequency to once per year and revised date to factor in time for HSPs to reconcile finances and close books before submitting declaration of compliance. The obligation now reads “Within 90 days of the HSP’s fiscal year-end.”

9.2(b) Acknowledgment of Funding Support

Added to conform to Ontario’s Visual Identity Directives.

Ontario and LHIN logos are strictly governed by Provincial policy. The provision in the M-SAA reflects what is required by Ontario’s Visual Identity Directives.

Summary of Main Changes Continued

What are the key changes between current and new M-SAA?

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REFERENCE DIFFERENCE REASON FOR CHANGE10.3(b) Governance Definition of “compensation award” added for clarity. The wording of the provision states that the compensation award is linked to

the CEO’s performance and a definition has been added in this regard.

10.4(c) Funding, Services and Reporting

Revised to reflect materiality. Language has been added to incorporate notion of materiality.

11 Limitation of Liability, Indemnity & Insurance

The insurance provisions have been significantly amended with input from the sector.

The insurance provisions have been updated to reflect sector specific risk.

12.2(a) Termination by the HSP

Revised to reflect circumstances where an HSP may require the ability to exit the Agreement on short notice.

Section 12.2(a) has been revised by inserting "(or such shorter period as may be agreed by the HSP and the LHIN)".

14.3 Terms and Conditions on Any Consent

Adjusted language to reflect reasonableness. The LHINs’ are always obligated to act reasonably and fairly in making its decisions and they do so.

14.8 No Assignment Added language to enhance clarity This section now states “no assignment or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor.”

Performance IndicatorsHealth System Indicators Initiative (HSII)

• In April 2010, the LHIN-led HSII was established to create a coordinated, system-based approach to indicator identification, development, maintenance and reporting.

• Central to the mandate of HSII is the close collaboration with provincial and national partners in order to leverage their organizational expertise related to indicator development, benchmarking, data extraction, and analysis.

• The revised mandate introduced in September 2013 provides a greater focus on alignment to system priorities, advancing system performance improvement through the SAAs and other mechanisms, and enabling monitoring and reporting.

• The M-SAA Indicators Work Group is accountable to the M-SAA Advisory Committee through the HSII Executive Group, comprised of 3 LHIN Senior Directors.

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Performance Indicators (Schedule E)Pan-LHIN Performance Indicators and LHIN-Specific Obligations

The Performance Schedule (Schedule E) contains the following two indicator sections:

1. Pan-LHIN Indicators are developed through the M-SAA Indicators Work Group through HSII (core indicators are relevant to all LHINs and all community sector HSPs; sector-specific indicators are only relevant to a specified sector).

• Performance Indicators are measures of HSP performance for which a Performance Target is set; Technical specifications of specific Performance Indicators can be found in the “M-SAA 2014-17 Indicator Technical Specifications” document.

• Explanatory Indicators are measures of HSP performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the “M-SAA 2014-17 Indicator Technical Specifications” document.

2. LHIN-Specific Performance Obligations: A section where each LHIN adds specific performance objectives and obligations for their HSPs is included. LHINs are committed to minimizing any undue burden placed on providers with respect to performance management by focusing on a limited number of outcome indicators aligned with local priorities.

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Performance IndicatorsWhy Performance Standards?

• All performance indicators have an associated target and standard of performance. Variance outside of the standard triggers the performance management processes in Article 7 of the M-SAA.

• The LHIN or the HSP can identify a Performance Factor that “…could or will significantly affect a party’s ability to fulfill its obligations under the Agreement.”

• The identification of a Performance Factor is made formally, in writing, to the other party and will include a description of the Factor’s actual or anticipated impact and a description of any action the party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor.

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Performance Indicators Continued

How are Indicator Targets and Corridors Determined?

• Following the submission of the CAPS, LHINs and HSPs discuss indicator targets that are appropriate to each organization and its local circumstances. Targets are expected to reflect performance and drive continuous improvement.

• To complete the targets and corridors for the performance indicators, the following principles will be employed:

• Where provincial targets and corridors exist, the LHINs and HSPs will take these into consideration

• Where appropriate, use past experience from M-SAA and MLPA indicators• Incorporate analyses of historical variation to inform corridor recommendations• Use % range for financial and volume indicators

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APPENDIX 1: M-SAA Planning & Schedules Work Group Membership

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Sector Organization Individual, Title

LHIN CW LHIN Brock Hovey, Senior Director, Health System Performance

LHIN CW LHIN Neil McIntosh, Director, Performance and Accountability

LHIN CH LHIN Patrick Manhire, Senior Accountability Specialist

LHIN HNHB LHIN Jim Borysko, Advisor ,Health System Performance

LHIN NE LHIN Kate Fyfe, Senior Director

LHIN SE LHIN Mike McClelland, Senior Financial Analyst

LHIN MH LHIH Shehnaz Fakim, Senior Lead, Health System Performance Management

APPENDIX 1: M-SAA Planning & Schedules Work Group Membership continued

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Sector Organization Individual, Title

LTC OLTCA Paula Neves, Director of Health Planning and Research

LTC OANHSS Jeffrey Graham, Director, Public Policy

CCAC SE CCAC Carol Ravnaas, Sr. Director Strategic Partnerships & Accountability

CSS Ontario March of Dimes Jason Lye, Associate Director

CHC Brock CHC Ron Ballantyne, Executive Director

CMHA Riverside Community Counseling Services

Jon Thompson, Director

MOHLTC MOHLTC Vanita Bhandari, Manager, Data Standards Unit , Health Data Branch

MOHLTC MOHLTC Christine Brown, Team Lead, Planning & Negotiations, LLB

APPENDIX 1: M-SAA Indicators Work Group Membership

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Sector Organization Individual, Title

LHIN NE LHIN Kate Fyfe, Senior Director

LHIN NE LHIN James Anderson, Performance and Contract Management Consultant

LHIN MH LHIN Heather Kundapur, Senior Lead, Health System Performance

LHIN TC LHIN Greg Stevens, Senior Consultant, Performance Management

LHIN NWLHIN Kevin Holder, Senior Consultant, Funding & Performance

LHIN ESC LHIN Pete Crvenkovski, Director, Performance Quality and Knowledge Management

LHIN HNHB LHIN Philip Christoff, Director, Quality & Risk Management

LHIN HNHB LHIN Rosalind Tarrant, Director, Access to Care

APPENDIX 1: M-SAA Indicators Work Group Membership continued

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Sector Organization Individual, Title

LHIN HNHB LHIN Gaya Amirthavasar, Health Information Advisor

LHIN HNHB LHIN Ted Alexander, Manager, Contracts and Accountability

CSS Cheshire London Angela McMillan, Attendant Services Manager

CSS Ontario March of Dimes Lee Harding, Director, Independent Living Services

CSS Dale Brain Injury Services Sue Hillis, Executive Director

CCAC TC CCAC Anne Wojtak, Senior Director, Performance Management & Accountability

CCAC OACCAC Rod Millard, Director, Information Management

CMHA Reconnect Mental Health Services

Mohamed Badsha, COO

APPENDIX 1: M-SAA Indicators Work Group Membership continued

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Sector Organization Individual, Title

CHC AOHC Jennifer Rayner, Regional Decision Support Specialist

LTC OLTCA Paula Neves, Director of Health Planning and Research

LTC OANHSS Dan Buchanan, Director of Financial Policy

MOHLTC MOHLTC Naomi Kasman, Senior Health Analyst, Health Analytics Branch

MOHLTC MOHLTC Soma Mondal, Manager , Health Analytics Branch

APPENDIX 2: M-SAA Content - Articles

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Article 1 Definitions & InterpretationClarifies terminology used throughout the document.

Article 2 Term and Nature of the AgreementDefines the term of the service accountability agreement as April 1, 2014 to March 31, 2017 .

Article 3 Provision of Services Describes how services will be provided in accordance with legislation, applicable policies, e-health/IT compliance and the terms of this agreement. Discusses subcontracting services and conflict of interest.

Article 4 FundingOutlines conditions of funding, payment and provision limitations. Procurement and disposition of goods and services are also described.

Article 5 Repayment and Recovery of FundingDefines circumstances under which funding may be adjusted and/or recovered

APPENDIX 2: M-SAA Content - Articles continued

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Article 6 Planning & IntegrationDiscusses multi-year planning CAPS requirements in alignment with LHIN IHSP and priorities.

Article 7 Performance Discusses the need for ongoing performance improvement and the mitigating process in the event of performance factors (non-performance).

Article 8 Reporting, Accounting and ReviewDescribes the obligations of reporting and record maintenance, French language requirements, disclosure of information, transparency and reviews.

Article 9 Acknowledgement of LHIN SupportHSP publications are required to note LHIN support, be approved by the LHIN, and indicate views do not necessarily reflect those of the LHIN or Government.

Article 10 Representations, Warranties and CovenantsConfirms the HSP’s ability to enter into the agreement and carry out the funded services with the appropriate governance, personnel and documentation.

APPENDIX 2: M-SAA Content - Articles continued

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Article 11 Limitation of Liability, Indemnity & InsuranceOutlines the limitation of liability and indemnification for the LHINs and the required insurance provisions for the HSP.

Article 12 Termination of Agreement Describes the parameters for termination of the agreement by the LHIN and by the HSP.

Article 13 NoticeDetails how notices to a party must be provided.

Article 14 Additional ProvisionsIdentifies additional provisions to the agreement.

Article 15 Entire AgreementDefines the agreement as constituting the entire agreement, superseding all prior agreements.

APPENDIX 2: M-SAA Content - Schedules

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Schedule Title Description

A Description of Services Describes the services delivered by the HSP, client populations and geography served

B Service Plan Describes the financial and statistical status of the HSP

C Reports Identifies, describes and sets due dates for HSP reporting

D Directives, Guidelines, Policies Identifies applicable MOHLTC policies

E Performance Identifies indicators, standards and local performance requirements

F Template for Project Funding Template used for funding special projects

G Declaration of Compliance Form to be completed by the HSPs Board of Directors to declare that the HSP has complied with the terms of the Agreement