Limited funding is hindering the introduction of RPM, DTx in Australia
Healthcare providers in Australia have been ‘slow’ to adopt remote care technologies such as remote patient monitoring and digital therapies.
Despite their widespread availability and verifiable and promising benefits, remote care technologies “(do not) fit neatly within broader financing models,” the Australian Productivity Commission report said. report about digital health.
The report notes that there are no dedicated reimbursement pathways for DTx, while reimbursements for RPM are limited to certain cases. It added that the reasoning between refundable and non-refundable items is not always a given.
For example, patients with type 1 diabetes can access subsidized products for continuous glucose monitoring and flash glucose monitoring through the National Diabetes Services Scheme. However, those with type 2 diabetes do not have access to subsidies, even if continuous glucose monitoring can improve outcomes and prevent diabetes complications. “
WHY IT MATTERS
Given these gaps in reimbursement and the high costs of some remote care options, patients may opt for subsidized in-person care “even if it is less convenient and more expensive to the system as a whole in the long run,” while some may forego care . .
It is also unlikely that practitioners will recommend remote care due to the lack of reimbursement incentives.
The Productivity Commission proposed tailoring financing, which requires setting clear parameters for which technologies should be funded. “Ideally, governments would limit any support for applications to those that are of high value and cost-effective,” the report said, adding that the existing Medical Services Advisory Committee or a similar body could help evaluate which devices qualify for funding .
However, financing models must “find a good balance”, the committee emphasizes. Funding should drive uptake and adherence while ensuring these technologies are appropriate for each patient and used in the right context.
A portfolio of financing approaches, the committee also said, “will likely work best.” This includes block funding for cases with potentially large patient cohorts, such as mental health; existing financing structures such as the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme, with some additional safeguards; and a flexible general funding stream for chronic disease management that includes remote care.
“(I)t is a mix of these financing models that will ensure the benefits of remote care can be fully realized,” the committee claimed.
“Regardless of which approach is taken, all future financing models will require careful calibration to get the right incentives and manage governments’ fiscal risks.”
THE GREATER CONTEXT
According to the Productivity Commission, RPMs are “in pocketbook use” across the Australian healthcare system.. Some major hospitals, such as the Royal Prince Alfred, run a “virtual hospital” service. Other hospitals, such as in Gippsland, have access to funding for RPM for patients with chronic diseases. There are also statewide programs such as South Australia’s Virtual Clinical Care and New South Wales’ Virtual Care – RPM.
Meanwhile, DTx “has yet to be widely integrated” into care patterns. They are not widely used by either patients or physicians, despite their interest. Since April, 31 DTx devices have been listed on the Australian Register of Therapeutic Goods. A few of them are from the local startup Mindset Health, which integrates hypnotherapy to help users overcome irritable bowel syndrome and menopause and quit smoking. Last year Mindset Health Raised $12 million in a Series A funding round, which went towards expanding the application of its DTx to other medical conditions.