Five new RISE products to support OHTs and OHT partners

In addition to the three packages of work profiled in last month’s RISE newsletter, RISE has prepared an additional five rapid syntheses focused on supporting OHTs and OHT support partners working through issues related to intersections with select health sectors and issues related to supporting local system leadership. These rapid syntheses summarize what is known based on the best-available synthesized research evidence and insights from other jurisdictions and from key informants. We summarize concluding messages for OHTs and OHT partners in the next five articles.

Synthesis 1: Establishing intersections between OHTs and home and community care

Little empirical evidence was found that addressed the outcomes of different contracting arrangements, the optimal size of provider organizations, the perspective of home care organizations holding multiple contracts with OHTs, or the inclusion of virtual care in contracting arrangements. The rapid synthesis identified three contract forms used in Australia, the U.S. and the U.K. with home care agencies – alliance contracts, prime contracts, outcome-based contracts – which exist in addition to more traditional fee-for-service contracting, although the context of contracting in each jurisdiction differs considerably. Effective implementation of contracts requires organizations to access: legal supports (to draft contracts), actuarial supports (to assess risk in contracts), technical supports (to understand population needs), business supports (to manage human resources and information technology), and clinical supports (to design clinical pathways).

Synthesis 2: Engaging primary-care physicians in OHTs and the OHT building blocks

Significant gaps exist in the literature on physician engagement in reforms generally (particularly as it relates to motivating participation), as well as engagement in each of the OHT building blocks, especially building block #1 (defined patient populations), building block # 3 (patient partnership and community engagement), and building block #5 (digital health). Strategies for engagement (which may also be used to push forward engagement in each building block) include: 1) establishing trust through meaningful and prolonged engagement efforts; 2) reinforcing physician identity within the reform (through dedicated communications); and 3) developing a shared local vision and communicating how it solves existing local problems physicians are facing.

Findings related to engaging physicians in particular building blocks, include the importance of:

  1. engaging primary care physicians in population segmentation (building block #2) which can be supported by asking for input into chosen segmentation variables, asking physicians to review results of their segmented high-risk patient subgroups (and allow them to add or remove patients using clinical judgement), and including patient risk level in EMR/EHRs; and
  2. engaging physicians in defining PREMs/PROMs for primary care (building block #4).

Synthesis 3: Establishing intersections between OHTs and long-term care

Partnerships between local integrated networks and long-term care homes were operationalized by:

  1. dedicating primary-care practices to commonly serve the residents of a long-term care home (through weekly long-term care home rounds)
  2. creating pathways of care with specific hospitals and specialists to preserve relationships between them and ensure smooth referrals (where needed); and
  3. capitalizing on digital health to support provider consultations and patient care.

 Synthesis 4: Establishing intersections between OHTs and public health

As OHTs mature, establishing partnerships with public health is particularly important given their expertise in population-health management (PHM), particularly the ‘third curve’ (using population-based strategies to address the determinants of health), which would include:

  1. building on PHM work that began during the pandemic (e.g., mobile vaccination units and housing initiatives)
  2. taking stock of and aligning OHT implementation plans with population-level initiatives that are already in place in the community, particularly those that serve populations with complex medical and social care needs and/or those that engage very specific services like oral health and the full array of broader human services; and
  3. involving and engaging local public health units in the development of ‘population health management and equity’ plans (given their experience and expertise), in part by finding ways to reassure units that they will not be subsumed by a healthcare focus.

Synthesis 5: Moving from organizational to local-system leadership

Significant literature was identified on capabilities for local-system leaders (aligned to the LEADS domains), however, there was a significant gap in the literature related to what motivates individuals to take on leadership roles or the factors that influence the process of leaders transitioning from organizational to local system leadership. Efforts identified to support the development of local-system leadership capabilities include mentorship and peer coaching (at the individual level), institutionalization of leadership development as an element of career development (at the organizational level), creating formal leadership-development opportunities such as establishing an institute to support ongoing leadership (at the system level), and adoption of a common leadership-capabilities framework (at the system level).