With the introduction of the Continuity of Care (CoC) threshold under the FHO+ model, many physicians are beginning to ask an important question:
“Where do I currently stand, and how close am I to 75%?”
While the framework itself is now defined, accurately calculating and projecting your CoC threshold remains limited by the data available today.
At DoctorCare, we’ve been actively working on developing CoC tracking within our Practice Care reports. As part of that process, we want to clarify what is currently measurable, what remains unknown, and the level of confidence physicians should expect in any estimates.
A Quick Refresher: How Continuity of Care Is Measured
At a high level, CoC is calculated quarterly as the percentage of in-basket services your rostered patients receive within your circle of care versus all in-basket services they receive overall.
- Numerator: In-basket services provided by you, your FHO group, and other eligible providers
- Denominator: All in-basket primary care services your rostered patients receive—regardless of where they occur
Physicians must maintain a minimum threshold of 75%. Falling below this level in consecutive measurement periods could result in a 15% capitation reduction.
While the formula appears straightforward, replicating the calculation outside of the Ministry is not yet possible with complete accuracy, given current data limitations.
What Can Be Measured Today
Using available billing data, DoctorCare can estimate your CoC performance through Practice Care reports by analyzing:
- Your own rostered (RA) services
- Services provided by FHO colleagues and locums in your group
- Outside use (CO), including walk-in and non-group visits
This allows us to generate conservative estimates of continuity, including a baseline using your own services versus outside use, and a more refined estimate that incorporates FHO group activity.
Together, these approaches provide meaningful insight into patient care patterns, where visits outside the group may be occurring, and your relative proximity to the 75% threshold.
For many physicians, this is enough to begin identifying risks and making targeted improvements.
Where the Data Gaps Remain
Despite these capabilities, there are several critical components of the CoC calculation that are not currently accessible in current data provided by the Ministry.
Missing Numerator Contributions
The Ministry includes several provider types in the numerator that are not visible in available billing data, including:
- GP-focused practice physicians
- HIV and Care of the Elderly physicians
- Hospital and emergency department in-basket services
- Other designated provider groups
Incomplete Denominator Visibility
While walk-in and outside visits are mostly captured, other services may be inconsistently represented or missing altogether. Some services, such as ER visits, may partially appear in the denominator without fully contributing to the numerator, skewing estimates.
No Full System-Wide View
The CoC calculation requires complete visibility into all in-basket care across the system, something that is not currently available to physicians or third-party tools. For example, missing hospital and ED contributions alone can materially shift results, but there is no reporting available to accurately account for this impact.
Because of these gaps, current CoC calculations should be understood as conservative estimates, not precise calculations.
In most cases, estimates will understate true continuity, but the degree of variance will differ by practice and cannot be precisely quantified today.
A Note on CoC Projections
As CoC becomes a key performance metric under FHO+, some solutions may begin to offer projections on whether physicians will meet the 75% threshold.
These can be useful for planning, but they rely on inputs that are not yet fully available. Even small data gaps can lead to meaningful differences when working around a fixed threshold.
For that reason, projections should be interpreted as directional guidance rather than definitive forecasts.
How DoctorCare is Approaching CoC Tracking
At DoctorCare, our approach is to provide clear, practical insights grounded in the data that exists today.
Through our Practice Care reports, we focus on:
- Delivering clear, conservative estimates of CoC performance
- Highlighting trends and changes over time
- Identifying actionable opportunities to reduce outside use
Most importantly, we want physicians to understand how to interpret the data, not just see a number.
As Ministry reporting evolves, particularly with the introduction of monthly CoC reports, we will continue refining our methodology to improve accuracy.
The Bottom Line
The introduction of a 75% CoC threshold is a meaningful shift in how performance is measured under FHO+.
However, the data required for precise calculation is still evolving. Until more complete information becomes available, all third-party estimates will carry limitations.
The most effective strategy today is to focus on understanding your patterns of care, monitoring trends, and making incremental improvements where possible. DoctorCare’s Practice Care reports are designed to support exactly that, helping you stay informed, prepared, and confident as FHO+ is implemented.
