In 2018/19, the Ministry of Health and Long-Term Care (MOHLTC), along with CorHealth Ontario (CorHealth) began to explore the possibility of implementing an alternative, population-based reimbursement model for patients with Aortic Stenosis (AS). Through preliminary consultation with experts, and review of evidence, CorHealth identified that there was an opportunity to change from the current method of volume-based funding of Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Implantation (TAVI), to a new Aortic Valve Implantation (AVI) reimbursement model.
The new AVI reimbursement model would enable a procedure agnostic, single payment for patients who have AS, and support both clinical and system improvements for the AS population.
AVI Reimbursement Model Project Goals
Improve patient access to most appropriate treatment (i.e. either SAVI or TAVI)
Prevent patient deterioration and mortality while waiting for treatment
Improve patients’ role in informed decision-making
Align AVI treatment options with current evidence, and in alignment with the OHTAC review of the intermediate and low risk TAVI patients
Reduce length of stay (i.e. TAVI is an early discharge model by design, this may be advantageous if TAVI volumes increase)
Reduce post-procedure complications
Decrease wait times
The project will encompass two phases:
- Model Co-Design and Pre-Implementation Planning Phase Implementation, Ongoing Evaluation and
- Model Refinement Phase
CorHealth received overwhelming response from the eleven advanced cardiac surgical centres with all eleven expressing keen interest to participate. Phase 1 work will be accomplished through the creation of the AVI Model of Care Change Management Forum (the Forum) whereby key stakeholders and clinical experts will inform components of the model. Phase 1 work will begin in September 2019 and continue through to March 2020.
CorHealth looks forward to sharing further project updates in upcoming issues of CorHealth Quarterly.