Ontario is improving care for seniors and others with complex conditions through Health Links. This innovative approach brings together health care providers in a community to better and more quickly coordinate care for patients with the greatest health care needs.
Health Links is a model of care where all providers in a community, including family care providers, specialists, hospitals, long-term care, home care and other community supports, are charged with coordinating plans at the patient level. This will help improve patient transitions within the system and help ensure patients receive more responsive care that addresses their specific needs with the support of a tightly knit team of providers.
Patients with the greatest health care needs make up five percent of Ontario’s population but use services that account for approximately two-thirds of Ontario’s health care dollars. Better coordination of care for these patients will result in better care and significant health system savings that can be devoted to other patients, ultimately improving the sustainability of public health care. Health Links will be integrated into sub-region geographies.
Each Health Link will measure results and develop plans to:
- Improve access to family care for seniors and patients with complex conditions.
- Reduce avoidable emergency room visits.
- Reduce unnecessary re-admission to hospitals shortly after discharge.
- Reduce time for referral from primary care doctor to specialist appointment.
- Improve the patient’s experience during their journey through the health care system.
To help further understanding of the benefits, roles of health service providers and the implications of a Health Link developing in your region please refer to the Health Links - Benefits, Roles and Implication for You.
Health Links Objectives
The development of Health Links across the province will continue to better support a high needs section of the population while beginning changes to our health care system that improve the long-term sustainability of public health care. Each Health Link operates with the same series of objectives in mind during the care planning process for each patient and their families and caregivers. These include:
1. Create care plans that can support each patient through their journey through the health care system. With important information from you, including your thoughts and preferences, the care plan provides clear direction for you and providers on the next steps in times of trouble.
2. Increase access to the right care at the right time and place for complex patients. This is in addition to the supporting role of your family physician.
3. Reduce the time from primary care referral to specialist consultation to lessen longer wait times and higher demand on emergency departments.
4. Emphasize planning for the immediate, short-term and long-term future care for patients upon initial discharge to reduce the number of 30-day readmissions to the hospital.
5. Educate patients and caregivers on how to access the appropriate resources in their communities that will enable them to receive proper care for conditions best managed outside of the ED.
6. Reduce the time between a referral and a homecare visit to provide support, comfort and service that will reduce the demand on EDs and hospitals.
7. Through care planning and foresight reduce unnecessary admissions to the hospital.
8. Connect patients with a primary care follow-up within 7 days of discharge from the hospital to educate the patient and their family on medications, care practices and setting up referrals for homecare visits.
9. Enhance the journey through the health system for all patients, particularly those with greater needs. Coordinating care plans between providers, care givers and the patient ensures access to the right services at the right time and place.
10. Achieve an Alternative Level of Care (ALC) rate of 9% or less. The ALC rate measures the percentage of hospital inpatients whose care may be better supported through another service/setting.
11. Deliver more value for the quality care that patients receive. Reducing costs, while maintaining the same level of health care, will support the long-term sustainability of the system.
Health Links in HNHB LHIN
Health Links supports the implementation of the HNHB LHIN's Strategic Health System Plan (SHSP) and will work to achieve its aim of dramatically improving the patient experience through quality, integration and value. At present, there are 11 Health Links in the LHIN as outlined in the map above, all are accountable to the LHIN, and every one of these 11 Health Links has already laid important foundations in their development and implementation.
HNHB LHIN Health Links
- Haldimand Norfolk Sub-Region
- Niagara Sub-Region
- Niagara North East
- Niagara South East
- Niagara South West
- Niagara North West Sub-Region
For more information, contact:
Linda Hunter, Director, Strategic Priorities
905.945.4930 ext. 4218