delivery modes as videoconferencing, home health monitoring, passive surveillance or wearable alarms, has a central role to play.
“Community telehealth solutions need to be designed for use by people with low technical acuity.”
Over the past few years, a number of telehealth pilot projects have been implemented through specific government research grants, including those related to the NBN rollout. These pilots have demonstrated a number of benefits:
• Videoconferencing into the home can dramatically reduce staffing and travel costs for activities such as medication administration, case conferencing and client education without compromising the quality of care • Monitoring devices, with information sent electronically to care providers, will enable clients to stay at home and avoid unnecessary and costly admission to hospital or residential aged care • Families remotely located from their loved ones are kept informed about their condition, can be engaged in their care planning and have greater peace of mind • With the right support older people appreciate the way new technologies help them manage their own care and enhance their independence. Despite the overwhelming benefits demonstrated through these trials, many cease when the grant funding concludes. While funded agencies are unable to sustain the programs and realise the substantial benefits, traditional service models remain unchanged and therefore inevitably unviable. Why is this so? There are two fundamental reasons. The first is that pilots are often conducted as standalone systems. As projects have a short-term duration, they do not integrate with the service delivery management systems for the provider agencies; therefore the agency does not make the investment in restructuring
their core businesses to take advantage of productivity improvements. The second is that although some of the benefits are achieved by the community care agency, there is generally a misalignment between the receiver of the benefit (i.e. the hospital, the nursing home through reduced admissions or the community at large) and the agency that has to bear the cost of equipment provision, solution integration and process re-design.
Sustainable models required What is required is a mechanism for agencies to be subsidised for the telehealth investments they make that result in benefits for other health providers and broader segments of the community. In primary care, the federal government has responded by providing MBS funding for telehealth consultations between general practitioners and specialists. The response in community care has been less supportive. Agencies are now permitted to use a portion of a client’s funding package towards telehealth services. However, the average spend per year for Home and Community Care-funded clients is around $1700; the average Community Aged Care Package provides around $7000 per client annually. Community telehealth solutions need to be designed for use by people with low technical acuity. Many products on
the general market require expertise in internet, iPads or mobile phones, which may be unsuitable for an elderly person with dementia. Solutions are required that take advantage of these technology developments, but are packaged and delivered so as to reduce the requirement for training and on-site support. A solution incorporating videoconferencing, monitoring devices, network and support may range from $1200 to $2500 per year per client (based on a three-year costing model), which makes it difficult for agencies to build them into affordable service delivery models while continuing to meet other essential care needs. If governments are really serious about slowing the unsustainable growth in the cost of healthcare in Australia, reducing hospital and nursing home admissions, responding to community preference to be cared for at home, and improving service efficiencies, then community care providers have an important role to play. New funding models need to be created that incentivise investment in innovative solutions and pass back some of the benefit that is gained by the broader community from the provision of telehealth services to the provider agencies. Some important telehealth pilots are due to be completed by June 30 2014, and the results from these projects will prove useful in substantiating the benefits to the community.
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