The Role of Shared Services in Supporting Ontario’s Move to Bundled Care and Value-Based Procurement

Health systems worldwide have been adopting value-based healthcare models to deliver better patient outcomes at the same or lower costs. Ontario, Canada’s most populous province, has also been progressing towards a more value-based healthcare system through the gradual implementation of more integrated care delivery and funding models, commonly known as bundled care. Although bundled care is no longer an entirely new concept in the province, implementation has been incremental and spanning only several patient conditions.

Generally speaking, a fixed payment is allocated for a defined episode of care to a bundle holder who, in turn, works to arrange care for the patient across multiple care settings. This funding model aligns financial incentives with outcomes, promotes care coordination and integration, and improves patient satisfaction. The model also helps to reduce the cost of care by supporting and shifting care to less resource-intensive settings. In the literature, providing care through bundled payments has demonstrated promising results for improving the value of healthcare spending in Ontario and other jurisdictions, such as the U.S. and Netherlands.

Building on the foundation of Quality-Based Procedures (QBPs) and the success of early pilot programs in Ontario, the Ministry of Health (MOH) began implementing bundled care programs at scale during the past couple of years. Since April 2019, a unilateral hip and knee bundle has been implemented across Ontario hospitals that perform joint replacement surgeries. For other bundles such as those that cover shoulder replacement surgeries, Ontario is taking a voluntary and phased approach to implementation due to the complexity of elements such as data collection, reporting, and wanting to assess lessons learned appropriately.