AFHTO, in partnership with the Osborne Group, has prepared a case study for AFHTO members which looks at how five Family Health Teams (Mount Forest FHT, Sunnybrook Academic FHT, City of Lakes FHT, Guelph FHT*, and South East Toronto FHT) have effectively embedded the Care Coordinator role within primary care. Their advice to other primary care teams, and the lessons they have learned in the process, include the following:
*Please note: The case study on Guelph FHT, which was completed in 2016, no longer reflects the current state of care coordination in the Waterloo Wellington LHIN region. The LHIN has opted for a different approach and is not embedding care coordination in primary care.
AFHTO asserts the role of primary care providers to lead care coordination. Primary care providers work to ensure access to interprofessional care for patients and identify a single point of contact to help patients and families navigate and access programs and services. The Ministry’s Patients First proposal speaks to deploying care coordinators in primary care. A number of teams have already done this and their experience can help other primary care teams as well.
AFHO has developed a series of case studies for our members to share the experience of colleagues on topics identified as being important to you: