C3 - Expanding Team-Based Care to Community Physicians through a Unique Integrated Primary Care Model

3. Integrated care and community responses

  • Date: Thursday, October 8, 2020
  • Concurrent Session C
  • Time: 3 :00 pm – 3 : 45 pm
  • Style: Live Workshop
  • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
  • Target Audience: Leadership, Clinical providers, Representatives of stakeholder/partner organizations

Learning Objectives

During this workshop we will share our early findings in implementing a unique integrated primary care model that expands access to inter-professional team-based care to primary care physicians in the community. We will highlight CarePoint Health’s (CPH) successes after its first year, physician engagement approaches and challenges, use of technology to facilitate information exchange across various EMRs and discuss key learnings. This includes how this model helped support some affiliated physicians during COVID-19.  CPH’s learnings can help inform system leaders and physicians on how solo and small group physician practices can participate in a collaborative, team-based approach to care regardless of payment model.


Evidence shows that team-based care and the principles of the Patient Medical Home enhances access to care and increases patient and provider satisfaction without raising health care costs. In 2017/18, the MH LHIN funded a new, innovative care model for an Integrated Primary Care Centre serving the South-West Mississauga and East Mississauga sub-regions. Patients in these subregions had very limited access to team-based care within the geography.    

CarePoint Health (CPH) opened in August 2019 to provide all patients of affiliated community physicians the opportunity to be part of a practice that provides the best possible care, regardless of payment model. It reinforces the patient-practitioner relationship as central to community-based family medicine. CPH also acts as an organizing body for physicians in the community and as a hub of collaborative planning within our network.    

Central to CPH’s model is an affiliation agreement between the physician and CPH for participating in this collaborative connected care model. The agreement requires a dual commitment to work together as part of the core team and the physician always remains the MRP for connected patients.  Patients are connected to CPH electronically and consult notes are sent back to the physician via HRM (unique in primary care) direct to the physicians EMR; facilitating information exchange between providers within the circle of care.    

CarePoint Health deployed a robust engagement strategy and has expanded team-based care to 50+ community physicians and their patients with positive results. This model has promise to support a healthy and sustainable primary care system in Ontario.


  • Judith Van Veldhuysen, Practice Facilitator, CarePoint Health
  • Dr. Casey Corkum, Clinical Director, Physician, CarePoint Health


  • Andrew Bilton, Executive Director, CarePoint Health