The next logical step for telehealth is hospital in the home care, according to allied health provider Jonathon Moody.
Integrated care has long been the gold standard for healthcare outcomes. Comprising a multidisciplinary team of practitioners who communicate with each other to provide patient-centred services, integrated care not only offers people the healthcare functions they need but also takes into account the context of their environment and lifestyle.
The results speak for themselves. If you can seamlessly move a patient from a hospital environment and get them home as soon as possible with the same integrated care approach, rehabilitation can be much faster in an environment that is meaningful to them. The rehabilitation process should be relevant and purposeful.
Hospital in the Home, also known as hospital substitute treatment, is a model that works well with integrated care. It’s designed to treat patients with illnesses or conditions that may need close monitoring, but who are not likely to deteriorate rapidly, at home. This minimises disruption to their lifestyle and enables hospital beds to be used for more serious cases.
During HITH, specialists and allied health professionals that provide service inside hospitals, can also service patients in their home. There are challenges, including costs that need to factor in issues such as travel time, which means practitioners see fewer patients.
Conversely, moving a patient out of the hospital helps free up much-needed beds that improves the bottom line to the facility. However, currently in many cases, the patient or their insurer is required to meet those costs, which in the short term discourages adoption of the model.
Rethinking of the value proposition by insurers is required to more wholly embrace the concept and change policies on inpatient and outpatient cost coverage.
Telehealth & HITH
Telehealth can assist in cases where patients need monitoring but don’t necessarily require in-person care. Continuing technology advancement means tools such as bluetooth-enabled monitoring devices are able to feed patient data to the practitioner.
The treatment can also be tailored to the home context rather than a clinical environment, which often doesn’t present an accurate picture of how the patient is tracking on a daily basis.
Telehealth is, of course, cheaper than travelling practitioners, but not a one-size-fits-all solution. I see good use of telehealth and HITH in situations as an adjunct for recovery from conditions that have may a standard rehabilitation protocol where the patient is charged with administering much of the therapy, but the practitioner is required to ensure compliance.
Factors, such as having a lower infection risk when the patient is treated out of hospital, support that position.
What COVID-19 and the emergence of telehealth technology and practices have taught us it that many telehealth treatments are very effective and hopefully that momentum carries through to the uptake of HITH in tandem.
System redesign
Despite the obvious benefits of pairing telehealth and HITH, the healthcare system is focused on hospital-based treatment, with the bulk of the public health budget going towards building and maintaining this overhead-heavy system without regard for more targeted outpatient care.
An inpatient’s care is generally covered by Medicare, a health insurer or a combination of both, but once at home, if the healthcare provider is not on board with HITH or telehealth, then the patient faces significant out-of-pocket expenses.
The other consideration is that hospitals are a hub of medical practitioners, they concentrate specialists and doctors that are involved in a particular type of treatment in one place.
If we were able to deploy these practitioners efficiently under HITH, we could reduce hospitals to a quarter of the size. Considering a hospital may cost $2-3 billion to build for not that many beds in relative terms, and how that money may be been better spent on supporting the required labour under a HITH model, practitioners could treat more people, and likely achieve better outcomes.
In the end, we will need a tripartite solution between the public healthcare system, private health insurers and health practitioners. Investing in home-based healthcare models takes effort and we need as much evidence as possible to prove its efficacy before we attract more interest to overhaul this area.
ED: Jonathan Moody is CEO and co-founder of Physio Inq.