Striking the Balance Between Financing & Advancing Mental Healthcare Services

Striking the Balance Between Financing & Advancing Mental Healthcare Services

“It speaks well to the fact that the health industry is moving forward in its quest to redesign care, but providers are painfully aware that the environment they are doing that in is fraught with other constraints that they have to be very realistic about.”

As Deborah J. Bowen, president of the American College of Healthcare Executives outlined to HealthLeaders back in 2014, the struggle to innovate while managing financial constraints is evident across all levels of healthcare practice, and is an issue which remains even more pressing today.

Reports on the concerns facing healthcare practitioners, highlighted by analysts ranging from the ACHE to PwC Health Research, all share a common theme; there is a fine balance to be struck between financing and advancing healthcare.

No Margin, No Mission

Our mutual goal as healthcare professionals, as noted by the HSE’s Integrated Care Programme for Prevention and Management of Chronic Disease, is “to design an integrated model of care that treats patients at the lowest level of complexity that is safe, timely, efficient and as close to home as possible”, but how does that translate in real terms?

It has long been established that healthcare providers, from large-scale hospitals to homecare clinicians, face the eternal challenge of providing high quality and easily accessible services to their patients. With the unquestionable and unstoppable arrival of increased consumerism in the field of healthcare, this issue has only become more urgent.  Increased access to knowledge on the patient-side and increased competition on the provider-side results in a very basic economic issue for providers. How do we lower the level of costs, while improving the quality of service?

For large-scale providers, the issue also deepens with vital considerations which must be given to the frontline healthcare workforce, at the coalface of this increasingly demanding challenge. In their latest report “Top health industry issues of 2018: A year for resilience amid uncertainty” PwC Health Research noted that “73 percent of provider executives say balancing patient satisfaction and employee job satisfaction is a barrier to efforts to improve the patient experience.” Despite being a ‘barrier’, this consideration can certainly be managed through engaging staff in additional training and promoting values. There is again, unsurprisingly, a financial outlay to this.

Add to this the harmful financial impact of patient no-shows, waiting list penalty charges, spiralling administration costs and a demographic tsunami that’s hitting developed countries’ health systems, it becomes painfully apparent that potentially avoidable expenses are escalating for healthcare providers across all levels, on a daily basis.

Innovate or Exit

The healthcare industry is aspiring, as other industries are, to implement the latest technological innovations in their services, AI, IoT, and so on. As the tech world innovates and grows at a rapid pace however, the mental healthcare industry is struggling to keep up. While the Healthcare and Life Sciences relationship is flourishing with new software or medtech research & discoveries the issue remains for day-to-day mental healthcare providers who may not have the finances to implement these latest advances as rapidly or easily as larger incumbents.

In addition, the patient is no stranger to the increased availability, accessibility and efficiency of everyday services. Simply look at the revolutionary success of AirBnb or Uber. Across the board, all industries have seen major changes in how they provide more on-demand services to their customers. Competition and innovation are not simply isolated to those already in the market. Last year we heard murmurings of Amazon Pharmacy, as the world’s consumer-driven powerhouse entered the discussion in the healthcare industries next stage of innovation. Teledoc launched a patient-facing online therapy service-Better Help in the USA. With new entrants of this scale possibly entering the market, what are small to medium healthcare providers to do, to keep up?

eMental Healthcare


A new survey by Mental Health Reform
 
found that 84% of Irish respondents feel that the health service places too little focus on mental health. One in ten adults in Ireland has a mental health difficulty at any given time, while almost 20% of young people aged 19-24 and 15% of children aged 11-13 years have experienced a diagnosable mental health disorder at some point in their lives. More shockingly, in May of this year, over 6,500 children and young people were waiting for their first psychological appointment.

With Government investment of over €200m between 2012 and 2018, the system cannot cope with the number of people looking for support. Mental Health Reform says staffing in mental health services is lower now than it was in 2008 and it is calling on the Government to boost investment in the area.

Speaking on RTÉ’s Morning Ireland, Mental Health Reform Director Dr Shari McDaid said: “The fact is, that if we invested in our mental health service, it would reduce costs throughout the health service because a lot of other health conditions are exacerbated by not having the mental health care in place.

Teletherapy & Telepsychiatry As A Solution

Telehealth- the online delivery of care or sharing of clinical information- has been widely regarded as a hugely positive step in healthcare innovation. Subsets would include offering services such as online therapy, electronic health records and secure messaging of protected health information. These simple and effective uses of technology seek to efficiently fight the battle against financial and technological issues for healthcare providers. Online consultation systems in both public and private sector would assist in maximising available resources, retaining tor re-engaging talented staff, facilitate triaging of waiting lists, increasing reach to remote, underserviced areas. The benefits are endless. 

Wellola: What are the benefits?

At Wellola, we believe passionately in empowering healthcare providers to develop accessible, affordable healthcare systems. We are committed to providing healthcare providers with the tools to deliver cutting-edge healthcare anywhere, maximise clinical outcomes & optimise their patients’ online journey. Our communications portal can work directly from a clinic’s own site.

  • Offer Online or In-House Care: Depending on your healthcare business, you may choose to attend to some or all clients through our secure video-consultation portal. For most, video-consultations act as a complement to in-person sessions. Wellola is unique in its design- patients can book either depending on your inputted availability. This facilitates in-house, blended or online therapy.
  • Triage Your Waiting List: Reduce your waiting list by offering low-acuity assessments and follow ups through our platform.
  • Fill Last Minute Appointments: No shows have been shown to hit clinic income by up to 10%. If there’s a no- show at your clinic, why not fill that slot with a telehealth appointment instead?
  • Offer A More Professional Service: Some clinics we spoke with are starting to use Facetime, Skype or Zoom but have found they can be a bit unprofessional or clunky for their less tech savvy patients. They are also missing the seamless link from booking through to treatment and payment. With Wellola, patients receive a text link with no third party downloads.
  • What are the features? Our software is simple to set up and easy to use. Features include (but are not limited to):
  1. Online Reservation For In-House & Online Therapy
  2. Seamless Video Consultation With No Third Party Downloads
  3. Integrated Online Payment & E-Invoicing Facility
  4. GDPR Compliant Messaging
  5. Secure Patient Portal

Irish-owned & backed by Enterprise Ireland, Wellola proudly services customers in the telepsychiatry and teletherapy space. Sign up for your 30-day free trial today at www.wellola.com. Questions? Please contact sonia@wellola.com or call 012988132 to arrange a demonstration of our software.

 

A New Model Of Healthcare To Serve The Irish People


“It is the first time that cross-party consensus has been reached on a new model of healthcare to serve the Irish people over the next ten years.” -Roisin Shorthall, Future of Irish Healthcare Committee Chair

The healthcare system in Ireland has been explicitly identified as a pressure area for our government, for our healthcare providers, and for Irish citizens accessing their services.

Sláintecare: A New Vision

Sláintecare is a vision for a new health service in Ireland, detailed and discussed in the report by the Oireachtas Committee on the Future of Healthcare published on 30 May 2017. With an investment of €2.86bn over the next decade, and a phased expansion of service provision, this strategy document outlines a wholly new model of healthcare for Ireland.

The aim or ethos of the plan? To provide a single-tier equitable healthcare system. The goal is to reach a stage where everyone will have entitlement to a comprehensive range of high-quality primary, acute and social care services, either at no cost or reduced cost. This ‘Stay Left, Shift Left’ style strategy will see the majority of services pushed out to community-based and home settings.

Some of the key action points include the introduction of Cárta Sláinte (which will entitle all Irish residents to access an ample range of services based on need, at zero or reduced cost), increased investment in community diagnostics, mental health teams, primary care and homecare services, greater assistance for people with disabilities and free GP care. This strategy seeks in the main to address the issue of access to our healthcare system, backing preventative medicine and reducing hospital admissions by facilitating care in primary or community settings.

Global Healthcare Goals

As we discussed previously, these fundamental changes are also being mimicked across the global health care sector. What lies behind this seismic shift in thinking? We are now presented with changing demographics, increased consumerism, and the realisation that healthcare has lagged behind other service industries who have embedded powerful information-based systems for decades. Our aging and growing populations, the proliferation of chronic diseases and a heightened focus on care quality and value have desperately demanded of us as clinicians and innovators to evolve new structures, treatments and technologies, to a find new way to care.

Across the board, the shared goals of healthcare strategies (Sláintecare included), encompass:

  • Improving digital connectivity between consumers and healthcare providers
  • Facilitating self-managed care, with the help of technology-enabled solutions, in a secure and safe environment
  • Delivering care outside the traditional clinical setting, ideally providing better access to care at a lower cost
  • Seeking to improve population health outcomes

 Preventative Care

One such innovation in the area of preventative medicine is not only the adoption but the technological advancement of ‘wearables’. A term stolen from the fashion industry & coined for use by Pulsar’s first calculator watch (1975), the meaning is so much more expansive in relation to modern medicine. Many health-related wearable innovations leverage the power of biosensors, which can be placed in a watch, a patch on the skin, implanted under the skin, or swallowed like a pill. In addition to the widely used activity tracker, or wearables that measure light, pressure, temperature, moisture, and gas, biosensors soon may be able to monitor chemicals and biomarkers. For example, doctors may be able to use biosensors to determine how well a drug is metabolized and adjust the dosage and frequency accordingly.

Corporate Healthcare Programs or Employee Assistance Programmes have also been a much welcome addition to models of preventative care (often in conjunction with wearables). Driven by key stake-holders such as health insurance firms, whose aim is to reduce the probability and impact of chronic disease in their patient population, some of us now have access to Irish Life Health’s Workplace Fitness Challenge, Laya’s Thrive Health & Wellbeing or VHI’s Corporate Solutions programmes. Paired with increased competition for forward-thinking, innovative, and engaging workplaces for the working population and the employers desire to reduce absenteeism, corporate healthcare programs now play a huge part in workplace culture and subsequently the preventative methodology. Many businesses in Ireland and abroad have been seen to incorporate health checks, onsite services and wellness programs, to give their staff more control over their personal health, all in the comfort of the modern workplace.

The question is where do wearables and employee assistance programmes fit in the public healthcare space? How can we draw on what works in the private sector and implement it in an accessible and affordable manner in the mammoth machine that is our public healthcare system?

 Community-based Care

The goal of free GP care does not come easily in real-world terms; the proposal is not practical unless it’s properly costed. “We certainly don’t have the capacity for it. In a utopian society there would be free point-of-care access. In reality, we don’t have the capacity to handle the increased consultations. The NAGP signalled this before it was rolled out for under 6s” – NAGP President Dr Emmet Kerin. Kerin says the fact more parents are bringing their children to their GP is “displacing other patients, particularly the elderly and frail”, many of whom go to their local emergency department when they can’t get a same-day appointment at their GP, further exacerbating overcrowding there. All societies that have universal free point-of-care access, such as the NHS are struggling with capacity.

Alongside GP services, community-based multidisciplinary care is also at the heart of stay-left thinking. For example, the John Hopkins Hospital at Home® program, an innovative care model for adoption by health care organizations provides hospital-level care in a patient’s home as a full substitute for the acute hospital setting. This model is improving care outcomes whilst also showing, in some cases, cost savings up to 30% compared to traditional inpatient care. The program is being implemented at numerous sites around the United States by many hospitals, home care providers, and managed care programs as a tool to cost-effectively treat acutely ill older adults, while improving patient safety, quality, and satisfaction.

On a local level, the closest we have to this is community-based public Primary Care Centres whereby multidisciplinary are based in local clinics and, where required, can attend to patients in their homes. One can of course, pay for their own allied healthcare provider to treat them at home, or avail of health insurance firms’ expanding gamut of community based services such as Affidea’s Expresscare walk-in clinics or VHI’s Hospital@Home service.

So how do we move care from acute hospitals to the community and home when the system is also struggle from a financial and resource perspective?

 Remote Care

As healthcare practitioners, telehealth is a tool that allows us to provide high-quality healthcare services to consumers, from the comfort of their homes. From preventative care to satisfying increased consumerism in healthcare, telehealth provides an important opportunity for healthcare practitioners to support the ‘Shift Left’ strategy (high quality, accessible care at a reduced cost). The success of once local, now global, providers VideoDoc, and UK-based Babylon Healthcare is weighty testimony that, from the patient’s perspective, a huge demand exists for online consultations with primary care physicians.

There are already some amazing products available in the Irish market that allow for home-based monitoring. Kinesis’s QTUG™ (Quantitative Timed Up and Go) is based on the Timed Up and Go test and is instrumented with wireless sensors placed on each leg. This technology provides a method for objective assessment of mobility, frailty and falls risk. Bluedrop Medical’s device enables diabetic foot ulcers to be detected early; the home-based device performs a daily scan of the patient’s feet and sends the data to the cloud for analysis through advanced algorithms capable of detecting abnormalities. By detecting falls risks and diabetic ulcers early, these technologies can meant treatment can be offered sooner, where outcomes and costs are greatly improved.

Day to day, what can healthcare providers do to join the journey?  With clinic software solutions, such as Wellola, now available, allied healthcare providers also have the tools to bring their care further into the community and directly into their patients’ homes. There now remains minimal barriers for all allied healthcare professional to drive the new vision for healthcare even further left.

 The Future Looks Bright

eHealth Ireland and the European Connected Health Alliance recently hosted an “Ecosystem Innovating for Sláintecare” event at Maynooth College. It was attended by patients, practitioners, entrepreneurs and key stakeholders in the Irish healthcare space. The atmosphere was one of optimism and motivation; there seems to be an urgency among this community to assist in the positive evolution of our healthcare system.  Placing the patient at the core of this evolution is key, as noted by patient advocate and 22q11 representative, Anne Lawlor “The end user needs to be present at the beginning….for integrated, connected care”. One couldn’t concur more with the closing statement of Professor Philip Nolan “If we could liberate the innovative potential within the people who work in the HSE we will have done something really significant for Irish society”. Watch this space; the future looks bright.

Innovations in USA Telehealth

Human hand touching robot hand

In the USA, urban dwellers and city slickers generally avail of healthcare services with minimal disruption to their daily lives due to local availability. However, this is not the case for 59 million Americans who live in rural areas, miles from the nearest healthcare provider.

The result? 59 million Americans are potentially at risk of poorer treatment. Undeniably, one method that mitigates the risk is telehealth. By its very nature, telehealth provides an effective and feasible alternative to the traditional in-person provision of healthcare services. This access issue for 20% of Americans, among other factors, has resulted in a positive and seismic momentum across many disciplines and locations for providers of telehealth.

According to a recent report by Grand View Research Inc., U.S. telehealth market is expected to reach USD $2.8 billion by 2022. Coupled with the increasingly affirmed view that implementation of telehealth solutions improves quality of care delivery to patients, the foundations for a hugely successful and effective change have been laid.

Of course, no major developments are without their occasional roadblock. One of these being the United States. federal legal system. While some states have made huge advances in implementation, the laws in many states have either been slow to materialise, or haven’t been passed at all. This leaves very apparent disparities between states, and a patchwork of law surrounding the industry, particularly in relation to reimbursement of service providers.

 

Increased Reach

However, as we have seen with many other countries, the best signs for telehealth implementation come from grass roots communities. For example, the Hancock County Healthcare Access Initiative. Hancock County, in Georgia, is a remote community where the only healthcare service in the area is the local ambulance or the community care centre. To combat their access issues, telehealth has come to the fore.

The basis of the initiative is to equip staff at the Community Health Systems clinic with telehealth kits. Residents would then be able to dial a toll-free number, and a nurse would visit the caller’s home in a WiFi-enabled van to conduct a virtual visit with the center.

“It’s a way to bring some healthcare to people who don’t often see it, but who do need it” says Dr. Jean Sumner, dean of the Mercer University School of Medicine and spearhead of the project.

Given the context, this type of service is vital for the people of Georgia. With a lower-income population generally living up to 60 miles away from the nearest hospital, simple access is a major issue. Couple this with a serious chronic health issue or the escalation of minor illnesses due to lack of early diagnosis, and the urgent need for telehealth here, and in many other states is blindingly apparent.

Admirable projects all across the US, like this particular example in Georgia, have become terrific examples of community-led change in healthcare provisions, with larger institutions also taking note.

 

Reducing Re-admissions

Avery Telehealth has also developed the Readmission Avoidance Program. Considering the fact that reducing hospital re admissions is the number-one money saving facet and selling point of telehealth, this program is a very welcome innovation. One estimate tells us that 75 percent of all hospital re-admissions are preventable. As it is, one in five Medicare patients are readmitted to a hospital within 30 days of discharge. One in three are readmitted within 90 days. So what is Avery Telehealth’s response?

Their Re-admission Avoidance Program focuses on proactive care transition planning, patient-centric post-discharge care coordination and remote telehealth monitoring.  The program serves as hub, essentially. Between the patient’s primary care provider and other community health providers, care is coordinated. The platform even executes hospital discharge orders. Re-admissions for patients with chronic conditions such as heart failure and chronic obstructive pulmonary disease have dramatically decreased thanks to this program.

 

Other Telehealth Innovations

The Robot

TeleICU, telepysch and telepediatric programs are already using the RP-VITA, the first FDA-approved telemedicine robot by InTouch Health and iRobot. With the robot’s state-of-the-art telecommunications and AutoDrive technology, doctors and nurses are able to focus solely on patient care while it operates independently. The robot can even be a remote stand-in for one doctor and collaborate with another doctor.

The Chair

Once the stuff of science fiction, there are now chairs that can offer basic medical assessments- built with a vast array of biosensors to measure basic vital signs, including weight, blood pressure, temperature, blood oxygen saturations, motion analysis and reflex response time. ComwellMedical’s Health-e-Chair can do all of this and even incorporates a communication unit with a remotely controlled camera. The patient only has to sit in the chair and let a remote clinician do the work.

What Can The Private Practitioner Do To Keep Abreast Of These Advances?

As a society, our advances in technology have allowed us to make dramatic and innovative changes in accessing vital services. Christine Calouro, of the Center for Connected Health Policy notes that progress has been encouraging. “In the future”, she said to Healthcare Analytic News, “the goal should be not to look at telehealth as its own unique means of care, but rather an inherent tool for providers, a guaranteed element of the healthcare system”.

As health practitioners, telehealth, allows us to provide high-quality healthcare services to consumers, from the comfort of their homes. The key to continued success now lies with those exact stakeholders, those providers who can implement Telehealth at grass roots level, day to day. With Telehealth software platforms now increasingly available, with increasingly secure, effective cloud-based technologies, there now remains minimal barriers for all healthcare providers to drive the change further.

Do you want to future-proof your business? Embrace telehealth as a tool in your private practice, to offer your patients greater access, and convenience; a better model of healthcare.