On January 17, Globe and Mail columnist Adam Radwanski wrote about the upcoming MOHLTC-OMA negotiations, focusing on costs and value for money (echoing the Auditor General of Ontario’s report). Unfortunately he used the term “family health team” when he was refering to physicians in capitated models in his statement, “The province will continue trying to get more family doctors away from fee-for-service. But that won’t do much good if it doesn’t get better value out of ‘family health teams,’ which a majority of doctors have already moved toward because the Liberals provided financial incentives to do so.”
AFHTO’s response appears below. To read the Globe column, go to: http://www.theglobeandmail.com/news/politics/adam-radwanski/ontario-sets-out-to-change-the-way-doctors-work/article2304673/
Dear Mr. Radwanski,
Thank you for your article this morning on the upcoming OMA-MOHLTC negotiations. You’ve hit on a number of key issues, including the need to know what value is being received from increased investment in primary care. As pointed out in Auditor General of Ontario’s press release regarding his chapter on Funding Alternatives for Family Physicians, “What concerned me about this was not that these doctors were making more money but rather that the Ministry of Health and Long-Term Care has not analyzed whether this has actually resulted in Ontarians getting better access to a doctor.”
I’m writing to you for two reasons —
One is to clarify and correct the terminology and concepts you used in your column. This is the challenge of the alphabet soup of Ontario’s primary care system! There is an important distinction between Family Health TEAMS (the term used in your column)and the methods for paying family physicians, i.e. Family Health Groups (FHG), Family Health Organizations (FHO), and Family Health Networks (FHN). The Auditor General’s report was focused on the latter (i.e. FHG, FHN, FHO). He reported that in the 2010/11 fiscal year, these three types of arrangements accounted for over 90% of family physicians (7,739) participating in an alternate funding arrangement and over 90% of enrolled patients (9.6 million enrolled Ontario residents).
Just over 2000 of these family physicians also participate in Family Health Teams (FHTs), and over 2.6 million Ontarians are enrolled. FHTs are organizations that bring together a group of physicians (FHO or FHN or salaried physicians) with other health care professionals (e.g. nurse practitioners, pharmacists, dietitians, social workers) to provide comprehensive primary care and health promotion for their patients.
In addition to reporting on FHG, FHN and FHO arrangements, the Auditor General’s report made a few brief comments to explain what FHTs are, and offered the following observation:
In December 2008, the Ministry commissioned the Conference Board of Canada to conduct a five-year study on Family Health Teams to identify their successes and shortcomings. Each year, the Ministry has been receiving interim study results, which focus on areas such as team functioning, patient access, and chronic disease management. The Ministry indicated that it will use the final report—expected in 2013—to assist it in determining whether any changes should be made regarding Family Health Teams. … We also noted that interim results of the Ministry-commissioned study on Family Health Teams have indicated that enrolled patients were generally satisfied with their access to health services.
We reiterate that the key issue, as pointed out by the Auditor General, is the need for a plan for on-going collection and reporting of data to monitor and improve on the value being delivered for Ontario’s investment in primary care. The only data from FHTs that is currently available is from the Conference Board study; the Association of Family Health Teams of Ontario (AFHTO) continues to encourage the Ministry to release the results to enable FHTs to learn from it and improve.
This brings me to point #2. FHTs have been committed to improving quality, and the interprofessional model has enabled a number of interesting innovations. I draw your attention to one example – Dorval Medical Associates Family Health Team – which monitors the quality, capacity and cost of their operation, together with a unique method for engaging patients in determining priorities, and uses the results to continually improve in all three of these domains. Over the past 3 years, Dorval has evidence of that accomplishment. A report on Dorval’s method and results is posted at – http://www.dorvalmedical.ca/about-us/the-dorval-model/
If you’d like to pursue any of this further, I’d be pleased to speak to you further about Family Health Teams and connect you to leaders and thinkers in this area. FYI — AFHTO’s ideas for improving value in the delivery of health care services are outlined in our presentation to the Drummond commission, posted at http://www.afhto.ca/news/afhto%E2%80%99s-submission-to-drummond-commission-on-broader-public-sector-reform/ .
Thanks again for your interest in bringing these issues to the public.
Association of Family Health Teams of Ontario (AFHTO)