Practicing Population-Based Healthcare in Quebec: Better Clarity for Better Quality and Costs of Care

Held October 14, 2014

The first of 4 webinars in our Caring for the 5% Webinar Series.


In healthcare, we often speak of “high users” as if they are created equally. Take the 55-year-old man with severe COPD (Chronic Obstructive Pulmonary Disease) who is in and out of the Emergency Department or hospitalized every time he has an acute exacerbation; or consider the 85-year-old woman with dementia, in hospital, awaiting a long-term care bed. Both patients fall into “the top 5%” category of those living with complex and chronic conditions and using a disproportionate amount of healthcare resources but their differences matter greatly. In fact, how we define "high user" has clinical and quality improvement implications.

The high user population is made up of people with different ailments, demographics and services use patterns who fall into two distinct patient groups: 1) a “frequent” or “repeat user,” such as the man living with COPD, who frequently visits the ED and is repeatedly hospitalized; and 2) a “long-stay user,” such as the woman living with dementia, who experiences prolonged hospital stays, including waiting for an alternate level of care.

Join CFHI as we learn about “high users” and the approach taken through the Défi Santé initiative in Quebec. Modelled after an approach taken by the NHS (National Health Service) U.K., this initiative uses a case management approach and enables a shift from a chronically sick to a chronically well population. With spread to more than 40 healthcare organizations across Quebec, Défi Santé offers concrete lessons for clarifying and stratifying your “high user” population, realigning existing resources, ensuring clinical buy-in and measuring and monitoring meaningful patient-level data. It’s an approach that leads to sustained population-based improvements for patients, clinicians and the health system.

Read more about this approach in a recent article by the speakers, Addressing the needs of high users of the health system: Where do you start?

Learning Objectives:

  • Learn how to identify your “high users” of care through a structured stratification approach that reveals the “frequent users” from the “long-stay users”
  • Identify the key elements of community complex case management and its alignment with population-based healthcare
  • Discuss how to measure impact using a new generation of patient-level indicators for clinical integration and quality system performance
  • Understand when and how return on investment may be calculated and communicated in terms of patient outcomes and system costs

Speaker Biographies:

LaFramboiseFrance Laframboise, RN, M.Sc., IMHL, ASC
Experte-conseil, performance clinique et gestion des maladies chroniques

Mrs. Laframboise has 25 years of experience in healthcare management, in particular at the Hôpital du Sacré-Cœur in Montréal. She also served as Director of the Quality of Care and Services at Des Sommets health and social service centre where she played a role of transformational leadership with teams in the adoption of modern changes to clinical and managerial practices.

Together with the EXTRA program, she has worked actively in better knowing and managing the highest consumers of care, a vulnerable cohorte of the population suffering from co morbid chronic conditions. Introducing collaboratively a renewed clinical model of community complex case management was also a highlight of the work done at the Des Sommets territory through the ‘’Defi-Santé’’ project. This project is recognized by the MSSS, the AQESSS and the Commissaire à la santé du Québec and is deployed in the majority of the health and social service centres in Québec. In doing so, she has collaborated with MédiaMed Technologies.

She currently collaborates with the Montreal health authority in improving clinical performance and better integrated care for the aging population and for those who suffer mental illness.

She is an administrator on the Board of the Ordre des infirmières et infirmiers du Québec and of the Ordre régional des infirmières et infirmiers de Laurentides-Lanaudière. She was a fellow of national EXTRA program, and is a graduate of the International Masters for Health Leadership program. She recently completed a certification in crown corporation governance and teaches quality of care and clinical performance at Université du Québec en Outaouais.

MireaultJean Mireault, MD, MSc
Chairman of the board and Vice-President of Clinical Affairs, MédiaMed Technologies (MMT)

Jean Mireault has 25 years of extensive experience in the healthcare industry, which spans from the province of Quebec to international affairs. He has worked with over fifty different organizations in the fields of data quality, clinical performance, and patient care. Jean has always believed strongly in the potential of his work and the difference he can make in the lives of others. High standards have clearly been a part of his life perspectives, in that he aims at transforming the Canadian healthcare industry for the betterment of all societies and communities.

With his Masters in health services from the London School of Economics and the London School of Hygiene and Tropical Medicine, Jean truly sees the value in understanding the newest industry trends and applying them to his work, especially for his projects involving frequent user management.

Prior to cofounding MediaMed Technologies, a company specialized in business analytics software and clinical consulting services, Jean held clinical performance management leadership positions at the International Federation of Red Cross and Red Crescent Societies in the Former Soviet Union, the Quebec Hospital Association, and four health organizations including the Health and Social Services Center of des Sommets. His interest in frequent users started when he mentored France Laframboise through the Extra project named “Défi-Santé” and it has grown exponentially since then.


Stephen Samis, Vice-President, Programs, CFHI

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Jennifer VermaJennifer Verma, Senior Director, Collaboration for Innovation and Improvement, CFHI

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