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Michelle O'Keefe



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    OS02 - Strategic Integration: A Global Perspective (ID 1)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 201EF
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      OS02.05 - Manitoba's Home Clinics: Aligning Continuity of Care, ICT, and Remuneration (ID 300)

      Michelle O'Keefe, Primary Health Care Branch, Manitoba Health, Seniors and Active Living / Sierra Systems; Winnipeg/CA

      • Abstract
      • Slides

      Purpose/Objectives: Manitoba is implementing a Home Clinic model to support primary care clinics in providing their patients with comprehensive, continuous, and coordinated care. Ensuring Manitobans have a Home Clinic, which serves as the home base for the majority of their primary care needs, is a key step towards achieving a longer term vision of a robust, equitable, and accessible primary care system. Home Clinics are based on the model described in the 2011 College of Family Physicians of Canada publication, A Vision for Canada, Family Practice, The Patient's Medical Home.

      Methodology/Approach: The development and implementation of the Home Clinic model in Manitoba has been a collaborative effort including Manitoba Health, Seniors and Active Living, The College of Family Physicians of Manitoba, Doctors Manitoba, Manitoba eHealth, fee-for-service clinics, and Manitoba's Regional Health Authorities. In 2015, a new Comprehensive Care Management Tariff, designed to support the adoption of the Home Clinic model, was negotiated with an implementation date of April 1, 2017, and focuses on the provision of comprehensive care to "Enrolled" patients with complex needs. The annual management tariff encourages a team based approach to care and requires that fee-for-service physicians use an EMR that can submit Manitoba's Primary Care Data Extract. This extract leverages the Primary Care Quality Indicators and includes prevention, screening, and management of chronic diseases, based on CIHI's primary care indicators. The implementation of Home Clinics has also required the development of a Home Clinic Registry, Patient Enrolment Repository, and changes to the Claims Processing System to support the new tariff. Extensive communications and change management supports have been established to help Home Clinic implementation.

      Finding/Results: The Home Clinic implementation is underway at this time. By April 1, 2017, it is anticipated that the majority of eligible clinics will have registered, worked through the details of enrolling patients, and will start claiming the Comprehensive Care Management tariffs for their eligible enrolled patients. Lessons learned and the results of the early implementation will be shared at this session.

      Conclusion/Implications/Recommendations: Home Clinics, Enrolment, and the Comprehensive Care Management Tariff are just the beginning of the evolution towards more comprehensive, continuous, and coordinated care for Manitobans. The Home Clinic and Enrolment Registry will serve as the foundation to allow improved information sharing and coordination between Home Clinics and episodic care providers. The next phase will focus on the ability for Home Clinics to publish a patient summary to eChart Manitoba, and to allow episodic encounter notes to be sent to the Home Clinic when a patient seeks episodic care outside of the Home Clinic. Driving policy change requires ongoing collaboration, understanding, and good faith negotiations between all parties, and a focus on ensuring that patients have access to continuous, comprehensive quality care.

      140 Character Summary: Advancing Patient-Centred Medical Home in Manitoba: Aligning Continuity of Care with ICT and remuneration - a lived experience.

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