FAQ: Integrated Funding Model
How do providers / OHTs develop an Integrated Comprehensive funding model?
These models are created alongside patient co-design driven by clinical teams that have early and frequent engagement with finance. The most important shift in thinking is: Patients first, funding follows. Current state processes and resource allocations documented by the care team can be used to develop future state care paths according to patient priority outcomes.
How do you fund the Integrated Comprehensive Care Model when there is no prescribed rate?
Both historical utilization and impact of anticipated changes in service delivery model and care paths inform funding. The finance team can use various tools for costing the care path including case costing (acute care), cost per visit modelling (post-acute), and allocating indirect costs. Defining the full care path requires specific details related to post-acute workload, but the future state can be developed and a standard cost methodology can be determined to cost the anticipated pre-admission, acute and post-acute phases of care.
How do you balance One Fund with no prescribed rate, and where does the money come from?
Historical resource utilization of each provider provides resource allocation recommendations. Efficiencies can be reported at various stages of the care path, service delivery or other areas (LOS savings, ED revisit efficiencies. Balancing these strategies requires agreement among all stakeholders and outlined contributions from hospital and post-acute providers to pool in bundled funding.
How do you manage the risk of being the One Fund holder?
Creating a risk/gain agreement in advance is important to consider the most likely scenarios with predefined mitigation plans for resolving concerns. This supports transparency, and builds trust among members of the One Team. Goals should be monitored and reported to stay within predetermined utilization and cost goals. A historical understanding of utilization patterns is useful for determining potential program volumes and care coordinator workload in post-acute care.
Who should be the One Fund holder?
Generally the hospital should be the One Fund holder because it is the organization with the greatest risks and gains related to a bundled care program. Pre-admit and acute care accounts for 85-90% of bundled care program costs and hospitals are the entry point for patients to the ICC program, so there is some control over volumes for elective cases. Risks and gains are shared across all partner organizations (One Team), regardless of who holds the funds.
Who is responsible for oversight of service delivery and achieving priority outcomes?
The One Fund holder is responsible, and works with all delivery partner organizations to optimize delivery, aligned with guiding principles and priority outcomes. If a partner organization has specific expertise to oversee and manage service delivery, they might be better suited for this task.
What data is available to help you understand utilization?
Utilization data is used to support rapid cycle change improvements and help build more up-to-date care paths for future care streams. All partners, including hospital, primary care, home care and community partners document in One Record (a shared digital health record) with transparent access to clinical records, patient phone calls and home care visit details. One Record is updated frequently by partners working together to track and reconcile volumes through Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS). Home Care service provider organizations (Home Care-SPO) need to be able to support the One Fund holder with utilization data of post-acute care so that the One Team members can take corrective action as necessary. Multiple systems that track patient visits by date, type, discipline, and other factors, finance and clinical teams can better understand the utilization and care path better to make informative decisions.
How does Integrated Comprehensive Care differ from current Bundled Care programs?
Bundled care is an enabler for integrated care. ICC is both an integrated service delivery model and an integrated funding model, whereas the MOH Bundled Care program only stipulates the integrated funding component, and could be implemented via existing service delivery models. This could however be a missed opportunity. Solely focusing on cost harmonization and cost containment would negate the additional patient, provider and system benefits delivered by the evidenced-based Integrate Comprehensive Care model. In following this wider approach, additional infrastructure and indirect costs such as care coordination can be incorporated in the integrated service delivery design and supported by the One Fund.