Since its inception, Ramsay Connect has been on a mission to bridge the gap between hospital and at-home care. Twelve months since it became operational, what has the organisation learned about providing out-of-hospital services?

Chief Executive Ian Galvin believes that, despite all the positive rhetoric and support surrounding the model, more work is needed to encourage greater utilisation of at-home services. Improved integration with hospitals, supportive funding, and greater trust, are among the levers needed to enact further meaningful change, he says.

A consistent framework

“Consumers and doctors who are engaged with these services are seeing fantastic outcomes,” said Mr. Galvin ahead of the Health Insurance Summit. “However, funding models underpinning out-of-hospital services are still relatively immature and, as a result, quite inconsistent.

“Generally, if a doctor wants to refer a patient to a hospital-based service, they will have funding available with every insurer in the country; which means clinical teams don’t have to think too much about the referral they are making.

“In the community space, however, no provider has comprehensive funding with every insurer. If there is no coverage – or the insurer has stipulations, like restrictions on the number of visits – it is sometimes easier for doctors to say, ‘that’s too hard we’ll send them to a hospital-based service instead’.”

When doctors default back to this approach, it limits the progression of the model.

“If faced with these restrictions too many times, doctors start to disengage with us and it’s hard to bring them back. That’s a shame because at-home care is often a more appropriate treatment option for the patient,” Mr. Galvin added.

Indeed, research shows that at-home care can improve health outcomes for some patients.

“For older patients, a hospital stay often worsens their overall condition,” said South Australian Minister for Health and Wellbeing Stephen Wade in a statement.

“It may disrupt their routine and sleep, reduce access to family and friends, and involve prolonged bed-rest which can rapidly decrease muscle strength. Receiving care in a familiar and comfortable surrounding benefits a patient’s overall wellbeing and improves treatment outcomes […].”

Meanwhile – with the rise of chronic disease and an ageing population – the case for making at-home care more mainstream is growing. At around $4680 on average per night to treat an acute admitted patient, hospital stays are an increasingly unsustainable way to provide and fund healthcare.

To further drive uptake of at-home services, funding models should also address the type of care provided, Mr. Galvin argued.

“In hospital settings – especially in the rehabilitation space – there are clear expectations around the type of care people will receive. In community settings, the opposite is true. Some providers are only funded for face-to-face consultations. Others have introduced new technologies with funding available on a hybrid basis,” he said.

“It would be useful for the industry to develop some consistent frameworks for these models. For example, bundled funding mechanisms can provide both pricing certainty and flexibility to deliver the individualised care a patient requires. Without consistency, it is hard to propel the product.”

Increasing trust

Alongside these limitations, Mr. Galvin believes trust between doctors and community providers needs further attention.

“There may be some mistrust about the level of care someone will receive in the community, as an alternative to hospital-based services. For example, there are some concerns about the current system enabling provider-centric – as opposed to consumer-centric – care,” he said.

An outcome- or value-based payment model may be a way to increase trust.

“We have found value-based care to be an interesting area and have already collaborated with a couple of insurance groups on this front. It’s a topic that’s been in the public domain for a long time, but I think it just takes a leap of faith to fund providers in this way,” said Mr. Galvin.

Integrating provider services with hospitals is another key way Ramsay Connect is fostering trust. It recently launched its cancer survivorship program, designed in collaboration with hospital-based oncologists and nurses, consumers, and community-based health coaches. The program is currently operating across four states, nationally.

“Historically, community and hospital groups have worked largely in isolation, which means the referral processes is generally quite ‘cold’. We are trying to address this by enabling a warmer handover between the two sectors at a national scale. For those who have historically had their feet in both camps – like some faith-based hospital groups – the integration is rarely at a scale needed to make a material difference to the sector, nationally.”

The organisation has already seen some early success from its integration efforts.

“Where some of the stand-alone community-based models are seeing engagement rates of 40 percent, our integrated models are showing rates of uptake north of 80 percent. Our NPS is also higher than most third-party community providers, which we believe is because of the integration,” said Mr. Galvin.

Finally, Mr. Galvin argues, improving the inter-relationship between hospitals, at-home care providers and funders may be as simple as a collective discussion about how to best move forward.

“We are trying to be part of the solution, but some things we need to work on collectively,” he concluded.

Ian Galvin is the Chief Executive of Ramsay Connect. Join him for more discussion on this topic at the Health Insurance Summit – due to take place 23-24 June 2021.

This year’s event will be held virtually and in-person at the Swissotel Sydney.

Learn more and register.