Understanding (and Using) Physician Networks for Ontario Health Teams
By Alexandra Piatkowski and Kandace Ryckman
You may have heard the terms ‘physician network’ and ‘patient attribution’ being discussed by the Ministry of Health in the context of assigning patients to Ontario Health Teams (OHTs). You may be asking yourself, ‘what is that?’ and ‘what does it mean for me and my OHT?’
As part of our tools for OHTs work, Health Commons has been discussing the same questions. Back in the summer, the Ministry held a webinar called ‘Defining the Ontario Health Team Population’, where researchers from the Institute for Clinical Evaluative Sciences, Dr. Thérèse Stukel and Dr. Rick Glazier, provided an overview of this work and fielded questions from participants. Here we break down what we’ve learned and what the policy implications may look like for OHTs.
What are Physician Networks?
Physician Networks are a way of linking patients to a single usual care provider, and then assigning a provider’s patients to a network based on previous utilization patterns. Using this methodology, 99% of Ontarians with a valid health card were able to be linked to a Physician Network (and thus to an OHT). The Ministry continues to refine the attribution model to ensure the methodology meets the needs of local partners and OHTs.
The important thing to note is that these networks are irrespective of geography of the patient’s residence (where someone lives) and are based on existing patterns of access and referral in the health care system. We’ve developed this slide you can use to get your stakeholders on the same page about how the methodology works.
Click to download our slide to share our simple visual explanation of Physician Networks with your team.
But what about geography?
It’s natural to think about populations geographically. In Ontario, we have traditionally used geography to plan health services – it's how we thought about LHINs and sub-regions. But geography doesn’t always reflect how patients access care. This is especially true in dense urban areas where there are many options for service. The Physician Networks take this behaviour into account and are centred around natural linkages between patients, providers, and health services.
Things you should know about Physician Networks
Original purpose: Researchers Dr. Therese Stukel, Dr. Rick Glazier and colleagues set out to build virtual accountable care networks by linking patients with providers and providers with hospitals. This work was published in 2013 with a goal of better understanding the central role for primary care practitioners in providing high-quality and low-cost care for patients with chronic diseases.
Patient flow: Organizing Ontario Health Teams around patient flow takes advantage of existing relationships between patients, physicians and hospitals. This evidence-based approach to attribution ensures that OHTs are aligned to how patients currently access the health care system.
Administrative data: Physician Networks use administrative health databases to understand utilization in Ontario. Only patients with a valid Ontario health card were considered in the methodology and services that are not billed to OHIP were not considered a factor in the attribution of patients. This currently includes services provided by Nurse Practitioner Led Clinics or Community Health Centres, although updates to the methodology could be made to include these services in the future. There is also a small percent of patients (<1%) who could not be attributed to a Physician Network because they did not access any health care services over the study period.
‘Specialty’ services: The methodology for Physician Networks focused on chronic disease management. As a result, when considering which hospital to attribute a provider’s patients to, maternal and surgical admissions were not considered. This means that hospitals where maternal and surgical admissions are a large part of their core business were generally attributed less patients. As the Ministry has not yet defined what will be constituted as ‘specialty’ services, there may be a need to update the methodology in the future.
Measure of loyalty: To test the validity of the Physician Networks, the researchers defined ‘loyalty’ as the proportion of care to network residents provided by physicians and hospitals within their network. On average, they found that network physician loyalty was 68% for all physician visits and 81% for primary care visits5. However, lower loyalty was observed in urban areas of Ontario due to availability of options for hospitalization.
Use Physician Networks for OHT Year 1 Planning
From our work, we’ve learned that data is the first step towards making informed decisions. OHTs in the ‘Full Application’ phase received a data package outlining their population, a map illustrating linkages, and health status and service utilization indicators for the attributed population.
As Year 1 planning begins for successful OHT applicants, here’s some questions to ask yourself:
Has our OHT engaged with all the physicians and associated organizations attributed to us through this methodology? Are there new partnerships we should seek out?
How does our attributed population compare to our geographic population? What nuances like travel time across our OHT should we be aware of when designing new initiatives and services?
Does the model address the needs of our target sub-population(s)? For instance, how do we address equity considerations like the needs of uninsured patients (e.g. newcomers, people with no fixed address, etc.) not currently included in the model?
This final question particularly resonates with us. At Health Commons, we strive to bring the social determinants of health to every health care discussion. It’s vital we don’t leave anyone out when planning for OHTs, if we want to promote more integrated care.
For applicants who will be invited to submit their full OHT application in March 2020, you may need to supplement the data provided in the Ministry package with other indicators on the social determinants of health. Check out the Population Health Assessment work we did with the newly announced Muskoka and Areas OHT for an example.
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The views and material presented here are not endorsed by any funders or collaborators of Health Commons Solutions Lab. Our work does not reflect the views or the policy development of the Ontario Ministry of Health. The Health Commons Solutions Lab is funded in part by the Ontario Ministry of Health and based at Bridgepoint Health (part of Sinai Health), with collaborators across Ontario.
References
Stukel, T. A., Glazier, R. H., Schultz, S. E., Guan, J., Zagorski, B. M., Gozdyra, P., & Henry, D. A. (2013). Multispecialty physician networks in Ontario. Open Medicine, 7(2), e40.