Healthcare providers in Australia have been “slow” to adopt remote care technologies, such as remote patient monitoring and digital therapy.
Despite their widespread availability and promising and verifiable benefits, telecare technologies “[don’t] fits neatly within broader funding models,” according to the Australian Productivity Commission Digital health report.
The report notes that there is no dedicated reimbursement pathway for DTx while reimbursement for RPM is limited to select cases. It added that the rationale between returnable and non-refundable items is not always consistent.
“For example, patients with Type 1 diabetes can access subsidized continuous glucose monitoring and rapid glucose monitoring products through the National Diabetes Services Program. However, people with Diabetes Type 2 cannot access benefits even though continuous glucose monitoring could improve outcomes and prevent complications of diabetes.”
WHY IS IT IMPORTANT?
Considering gaps in reimbursement and the high costs of some telecare options, patients may opt for subsidized in-person care “even if it is less convenient and more costly for whole system in the long run”, while some people forgo care. .
Practitioners are also unlikely to recommend telecare due to the lack of reimbursement incentives.
The Productivity Commission proposed a funding overhaul that would require setting clear parameters on which technologies should be funded. “Ideally, governments would limit any support for apps to those that are high-value and cost-effective,” they said, adding that the Health Services Advisory Committee current or a similar agency can help evaluate what equipment can be included in the grant.
However, funding models “need to strike a good balance,” the committee emphasized. Funding must encourage uptake and adherence while ensuring these technologies are appropriate for each patient and applied in the appropriate context.
The commission also said a portfolio of funding methods “is most likely to work”. This includes block funding for cases with large potential patient populations such as mental health; existing funding structures such as the Medicare Benefits Program and the Pharmaceutical Benefits Program, with some additional protections; and a flexible pool of funding for chronic disease management that includes telecare.
“[I]The combination of these funding models will enable the full benefits of remote care to be realized,” the committee stated.
“Regardless of the approach adopted, any future funding model will need to be carefully calibrated to get the right incentives in place and manage governments’ access to finance .”
THE LARGER CONTEXT
According to the Productivity Commission, RPM is “used in pockets” across the Australian health system. Some major hospitals, such as Prince Alfred, operate “virtual hospital” services. Other hospitals, such as those in Gippsland, have access to RPM funding for patients with chronic diseases. There are also state-wide programs such as South Australia’s Virtual Clinical Care and New South Wales’ Virtual Care – RPM.
Meanwhile, DTx “has not been widely integrated” into care models. They are not widely used by patients nor by physicians despite the interest. As of April, 31 DTx devices were listed on the Australian Register of Therapeutic Goods. Some of them are from local startups Mindset Health, integrates hypnotherapy to help users overcome irritable bowel syndrome, menopause and quit smoking. Last year, Mindset Health raised $12 million in Series A funding, aiming to expand its DTx applications to other medical conditions.
