Expanding valuable hospital models can inadvertently pull patients from lower-cost settings, like primary care. But there are leap-frog moments at hand.
Even the most virtuous of models can scale poorly and move patients to higher cost care settings, says Emily Mailes, chief eStrategy officer for Victoria.
Speaking at Australian Healthcare Week last week on how to use digitisation to bring tangible benefits to patients, Ms Mailes said it was important to consider the repercussions of scaling new models, irrespective of their virtue.
“You can scale the wrong way, and you can create unintended consequences,” she said.
“Sometimes when we create an innovation in the hospital sector and it’s an amazing experience and it costs less than the old way, [we think] let’s grow this … but we inadvertently or advertently capture demand from lower-cost settings.
“We bring people in from community care, from primary care.
“We want them to experience this new virtual care model, but actually we’re increasing the cost-to-serve of that patient.
“We’re growing these acute services, because that’s where the innovation is happening, rather than shifting the demand out to lower-cost settings.
“We need to avoid that.”
The aim should be to transform patient pathways, rather than discrete services.
“A lot of the innovation that we’ve done in healthcare has really targeted a service, a specialty, a customer or consumer model of care or experience, and we’ve achieved some really cool and innovative things,” said Ms Mailes.
“But when we’re not solving for how that service fits into a longer pathway, we are still fragmenting that consumer journey.
“We’re not unlocking that end-to-end value.”
Demand therefore needs to be shifted, rather than created.
“We know that if we can shift someone from a hospital bed into the community, someone comes into that hospital bed. There’s a line out the door,” said Ms Mailes.
“We know that it’s difficult to shift that kind of demand, but we have to find ways that we can decommission old models and create new, more efficient models.
“If we don’t, then we have the traditional way of delivering care over here – it costs the same as it always has, or more probably because that cost is going up – and then we have a whole new set of channels of digital care that have their own cost and complexity, and we’re adding cost into the system rather than removing it.”
Australia is stuck on the lower rungs of digitalisation, without being able to progress to connected and personalised, proactive care, she said.
“[Personalised, proactive care] is tricky, because to do that well, you have to bring social determinants of health data in, you need to collaborate with other public sectors, you have to change people’s behaviour, and that is difficult,” said Ms Mailes.
“But there’s an imperative for us to figure out how to do that and how to move up this scale much more quickly.
“Luckily, this doesn’t need to be a linear journey any longer.
“There are genuine leapfrog opportunities that are emerging.”
A hardware example of a leapfrog opportunity would be physical workstations that are coming to the end of their life, said Ms Mailes.
“We could invest in tablets instead. They’re easier to protect, from a security point of view, lower cost [and] you can turn them over faster as technology advances.
“From a software perspective, if we take it forward a little bit, the future of a system of record in any industry is going to be a blob of data with a generative AI interface on top.
“Very much oversimplifying it, but if you can then apply that as a concept to our EMR and our interoperability issues, if you can let that technology advance a few years, then what’s going to be possible instead of all of these API integrations, instead of flipping and replacing our EMRs?
“There are actually going to be much simpler ways of addressing these issues.”
