"We have the system we've incented... if we want something different we will have to incent it differently."
- Kevin Smith, CEO St. Joseph's Health System

As Ontario experiments with new patient-based payment methods under the Excellent Care for All Act, The Change Foundation offers analysis, examples, and advice on using funding models to improve the quality and experience of patient care.

The report, Tools for Change: Funding Incentives and Levers for Integrating patient care in Ontario (November, 2010), flows from a symposium The Change Foundation organized last spring with support from the Ministry of Health and Long-Term Care. The paper includes Canadian examples of funding/incentive models, a summary and lessons from the symposium and the U.S./U.K. case studies, as well as key findings from the literature.

What's worked where and why? Do we need a mix of strategies? How can we rethink and redesign Ontario's funding models and payment systems to incent providers to work together in the best interests of individuals and their caregivers as they move through the health-care system?  While recognizing that leadership and culture are key levers in making change happen, the report focuses on payment systems, and their associated intentional or unintentional impacts on care.
Insights from inside & outside Canada

The report includes findings from two commissioned case studies, one on the U.S. Federally-Qualified Health Centres and another focused on U.K. Incentives to improve primary care. Within Canada, other jurisdictions are also trying and testing different models and incentives, including: Alberta's introduction of activity-based funding starting with long-term care facilities in 2010-11; and B.C.'s decision to bring in patient-focused funding in hospitals by 2012-13. The question remains: which funding methods best facilitate system-wide integration?

Eight take aways:

• Use funding mechanisms to support strategic priorities; system-wide impact matters
• Move beyond provider-based funding models; organizational span matters
• Include primary care in system planning.
• Blunt the effect of fee-for-service (FFS) payment models .
• Use non-financial incentives to appeal to excellence
• Build a culture of quality; financial incentives alone can't change culture
• Make accountability and performance reporting play a bigger role; governments must clearly articulate goals and policy objectives so provider organizations can be held accountable for delivering.
• Maximize good features and remove perverse incentives; apply continuous improvement to funding reform

To hear one example of creating an integrated health system close to home, listen to a new wide-ranging feature interview (part of our Integration Incubator series) with Kevin Smith, President and CEO of the newly integrated St. Joseph's Health System and Foundation board member. St. Joseph's offers a continuum of services spanning acute care, long-term care, community care, rehabilitation, hospice, and mental health.
And if you haven't already listened to the video podcast of Change Foundation CEO Cathy Fooks in conversation with U.S. Governor Howard Dean, who was the keynote speaker at the spring symposium, have a look and listen: Dean says the U.S. system must move beyond current laudable insurance reform to focus on deeper issues of quality and integration.
Read the full report, and related resources.  See pictures from the symposium.