The Forum

A prescription for Ontario's 'Hallway Medicine' crisis

by Vidal Seegobin, Liz Jones, and Paul Trigonoplos

The hallway medicine crisis is alive and real in Ontario. In nearly every phone call we have with executives in the province, we've heard some version of the following: "We are running at or above 100% census. We're just trying to stay afloat." And because of the magnitude and scale of this problem, the new government has made 'solving hallway medicine' their number one health priority in 2019.

Two necessary strategies: Building supply and reducing demand

The government is running to the supply side of the equation to deal with this problem. There is a rush to build new acute and long-term care beds over the next decade—but while this is an important part of the solution, it is not the only part.

The average hospital, unless it has financial support from the government, would have to invest a tremendous amount of its own capital to increase bed supply to necessary levels. What hospitals have more control over, however, is the demand side of the equation: taking steps to reduce how many patients are coming in to their systems.

When we look globally at how systems succeed at reducing this demand, they almost always begin with the high-risk population. This approach makes sense, given this population's high demands on and cost to the system—data show that patients with three or more conditions are between four and eight times more likely to readmit than healthier people.

Time to scale up?

Most markets around the world have developed a national or provincial high-risk strategy aimed at reducing acute demand and promoting self-management in the community—Vanguards in the UK, Health Links in Ontario, and the patient-centred medical home in the United States and Australia. But we are at the point where these models are becoming outdated, and therefore need to be refined before they are scaled up to cover more of the booming chronic, complex population.

In Ontario specifically, in response to our members' continued capacity and budgetary pressures, we worked to understand what they could do differently to scale their current approaches. We examined various global high-risk models, and distilled what we learned into insights to guide our members' high-risk strategies.

Three focus areas for success

Our newest research study helps executives think through three focus areas to perfect and scale their high-risk models: targeting the right patients, removing non-clinical barriers to self-management, and helping patients self-manage in the community.

On 7 March, we will share this research with our members at our annual chief executive roundtable in Ontario, Canada. Attendees will come away with an executive audit to ensure that the care models they're relying on and investing in have the right components and will in fact yield the hoped-for returns.

To register for one of these meetings, click here, or email us at gfhi@advisory.com

Next, learn how to support high-risk patients with underutilized services

Managing high-risk patients takes a whole team. The most successful systems are working across the organization to ensure care managers are accessing all of the resources available to them. Read on to learn the four areas to tap for collaboration.

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