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VBHC Case Studies

Paramedics Providing Palliative Care

Description:

Paramedics were trained to assess people with palliative care needs (for example, pain management) and treat them on the spot at home. Paramedics are trained to provide this care without a transfer to hospital, if appropriate.

Finding Value in Palliative Care

Targeted Outcome

Enabling palliative patients to receive care at home, where most prefer to be

Resource Considerations

Reduced costs associated with fewer ED visits + saving paramedics’ time

Results:

• 60 per cent of 9-1-1 calls resulted in people being treated at home instead of being transported to the emergency department (compared to 90 per cent of 9-1-1 calls typically resulting in emergency trips); 
• Paramedics saved an average of 31 minutes per visit by treating palliative patients at home compared with transporting them to the emergency department; 
• A return of $4.60 for every one dollar invested in the program; and 
• Over 92 per cent of surveyed patients and families were satisfied with the care they received by paramedics. 

 

ImagineNation Challenges

Description:

From 2011-2016 Canada Health Infoway used Open innovation challenges to reward innovators for making progress towards pre-defined goals related to the adoption of digital health solutions. Open Innovation Challenges specify the outcome to be achieved, not how it must be achieved. This approach can yield value by ensuring the outcomes to be achieved matter to patients (numerator) while controlling costs by only awarding money to those who best meet the outcome (denominator).

Finding Value in Award Challenges

Targeted Outcome(s)

Adoption of digital health solutions prioritized by Canadians

Resource Considerations

Resources went to those who best met the targeted outcomes

Results:

• $2.3 million in awards was distributed to 435 team or individual recipients
• Collectively, teams' digital health solutions were used almost 75 million times during the challenges: 3.5 million times for consumer-focused solutions and 71.4 million times for solutions designed to be used by clinical teams
• Outcomes varied by individual challenge but included things like growth in the use of digital health solutions for e-booking, patient access to health information and medication reconciliation

 

Cardiac Device Procurement

Description:

Value-Based Procurement awards contracts based on quality/outcomes and cost, rather than costs alone. In 2018 the Ontario Ministry of Health and Long-Term Care - in collaboration with industry partners, hospitals and a patient panel - developed an RFP to procure cardiac devices. It included a focus on outcomes important to patients (e.g. device longevity that reduces the need for future surgeries), in addition to efficiency through large volume purchasing.

Finding Value in Procurement

Targeted Outcome

Product requirements that reflected patient and health system priorities

Resource Considerations

Initial purchase costs, as well as longer-term resource use (e.g. future surgeries to replace devices)

Results

• Including a patient panel in the procurement process resulted in a focus on product requirements that were important to patients, such as device longevity to minimize device replacements, and compatibility of devices with magnetic resonance imaging (MRI)
• Savings were realized by procuring a large volume of devices at a provincial level, rather than individual hospitals procurements

 

Bundled Funding for Hospital to Home Pathways

Description:

Bundled payments are for specific procedures or groups of patients that are designed to cross traditional silos to ensure funding follows the patient. This funding method was implemented in 2015 for some Ontario Hospitals and homecare providers through the Integrated Funding Model (IFM) Initiative. This initiative consisted of 6 programs addressing 4 target populations, piloting pathways combining hospital and home care for a fixed amount of time post-discharge (e.g. cardiac surgery).

Finding Value Across Silos

Targeted Outcome

Smoother surgery experience, including pre- and post-hospital care.

Resource Considerations

Decreased costs associated with reduced 30-day ED visits/ readmissions and length of stay

Results:

• The IFM program was associated with positive patient outcomes and reduced healthcare costs
• Hospitals who participated in IFMs saw improvement in a number of key metrics:
  
  • Length of stay decreased 10%
  • 30-day ED visit/ death rate decreased by 19%
  • Average 90-day total costs decreased by 10%
• The cardiac surgery project was found to be particularly successful given the care pathway was well-defined, time-limited, and generally consistent across patients

 

Sweet Dreams Social Impact Bond

Description:  

The Sweet Dreams Project in Saskatoon, Saskatchewan used a Social Impact Bond to provide vulnerable mothers and children with housing, parenting support, access to educational opportunities and employment skills development. Social impact bonds are a pay for success investment model where capital from private investors is used to pay for programs or services that enhance social good. Investors' return on investment depends on the achievement of pre-defined social outcomes.

Finding Value in Social Impact Bonds

Targeted Outcome

Keeping at-risk children out of foster care

Resource Considerations

Initial investment of $1M from private investors, with a 5% rate of return if outcomes are met

Results:

• The five-year goal of the Sweet Dreams project was to keep 22 children out of foster care by keeping them safely with their mothers continuously for more than six months after participating in the program. 
• As of 2019, 54 of the 55 children involved in the Sweet Dreams project had remained out of the child welfare system.
• Some mothers in the program received early learning and child care training, and many began working at the Sweet Dreams Early Learning Centre.
• The program won the 2019 Governor General’s Award for Innovation.
• In 2019, The Government of Saskatchewan committed to $120,000 in ongoing annual funding for Sweet Dreams, based on the success of this Social Impact Bond. As of 2025, the Sweet Dreams program continues to operate through EGADZ, a non-profit community-based organization.