The Ministry has issued a call for applications for demonstration projects from general and family practice physicians and groups across the province to provide multidisciplinary care for individuals, who have high medical and functional care needs, may have a high number of interactions with the health care system and may have a high risk of hospital admissions and/or re-admissions. This is another call arising from provisions in the 2012 Physician Services Agreement, following last Friday’s close of the call for applications to expand IHP services in community. The key elements of such a demonstration project should include:
- A target population of medically complex patients identified using a pre-defined identification method;
- A core team of providers which can include physicians and inter-professional health providers;
- Transitional Care Services including bundled evidence based services aimed to stabilize the patient at home and prevent re-admissions, and/or Medical Home Services including a wide range of services tailored to medically complex patients’ needs;
- Collaborating partnerships.
Demonstration projects will be funded for a 12 month period starting October 2013. Approved applicants will be expected to track evaluation metrics and to participate in a full project evaluation upon completion of the demonstration project. Funding may be paid directly to the physician or a physician group depending on the specifics within the application. The weblink to the live application is now available at http://www.health.gov.on.ca/en/pro/programs/complex/. Physicians will receive mailed information regarding this initiative starting today (Aug.19).