The Issue
Since instituting a series of reforms to encourage the use of patient-centered medical homes, interdisciplinary models of care, and incentive-driven payment arrangements, the Canadian province of Ontario has made significant strides in improving the quality and availability of primary care. The authors of this Commonwealth Fund–supported study describe early results and challenges of the reform effort.
What the Study Found
Among the key changes made in Ontario was the establishment of patient-centered medical homes and community health centers that rely on interdisciplinary teams of providers, including nurses, dieticians, mental health workers, social workers, and pharmacists. Over 10 years, the number of physicians working in teams has increased from 176 to 3,000.
Ontario also introduced new methods for reimbursing primary care providers, incorporating fee-for-service, capitation, and blended payments. Under the new payment models, providers receive premiums for providing reproductive care, palliative care, and home visits, as well as pay-for-performance bonuses linked to preventive care and chronic disease management. Total payments to primary care providers increased by 32 percent between 2006 and 2010.
The government also gives subsidies and technical support to physicians so they are able to implement electronic health records (EHRs) and other clinical management systems; the percentage of family physicians who reported using an EHR increased from 44 percent in 2009 to 65 percent in 2012.
Conclusions
Ontario’s health reforms have led to rapid improvements in access to care, patient and provider satisfaction, and health system efficiency. But ensuring that the reforms reach their full potential will require meaningful performance measurement, risk adjustment, and ongoing investment in the new care models.
