Healthcare providers in Australia have been "slow" in their uptake of remote care technologies, such as remote patient monitoring and digital therapeutics. 

Despite their wide availability and verifiable and promising benefits, remote care technologies "[don't] fit neatly within broader funding models," according to the Australian Productivity Commission's report on digital health. 

The report noted that there are no dedicated reimbursement pathways for DTx while reimbursements for RPM are limited to select cases. It added that the rationale between reimbursable and non-reimbursable items is not always a given. 

"Type 1 Diabetes patients, for example, can access subsidised continuous glucose monitoring and flash glucose monitoring products through the National Diabetes Services Scheme. However, those with Type 2 Diabetes cannot access subsidies even where continuous glucose monitoring may improve outcomes and prevent diabetes complications."

WHY IT MATTERS

Considering these gaps in reimbursement and the high costs of some remote care options, patients may opt for subsidised in-person care "even if it is less convenient and more costly for the system as a whole in the long run," while some forego care. 

Practitioners are also unlikely to recommend remote care due to dearth of reimbursement incentives. 

The Productivity Commission suggested tailoring funding, which requires setting clear parameters on which technologies should be funded. "Ideally, governments would limit any support for applications to those that are high value and cost-effective," it said, adding that the existing Medical Services Advisory Committee or a similar body can help evaluate which devices may be included for funding. 

Still, funding models "need to strike a fine balance," the commission stressed. Funding must incentivise uptake and adherence while ensuring these technologies are properly suited for each patient and applied in the right contexts. 

A portfolio of funding approaches, the commission also said, is "likely to work best." This includes block funding for cases with potentially large cohorts of patients such as mental health; existing funding structures such as the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme, with some added safeguards; and a flexible general funding stream for chronic disease management that covers remote care.

"[I]t is a mix of these funding models that will allow the gains of remote care to be fully realised," the commission claimed.

"Irrespective of which approach is adopted, any future funding models will require careful calibration to get the incentives right and manage the fiscal exposure of governments."

THE LARGER CONTEXT

RPMs are "used in pockets" across the Australian health system, according to the Productivity Commission. Some major hospitals, like the Royal Prince Alfred, run a "virtual hospital" service. Other hospitals, like in Gippsland, have access to funding for RPM for chronic disease patients. There are also statewide programmes such as South Australia's Virtual Clinical Care and New South Wales' Virtual Care – RPM.

Meanwhile, DTx "have yet to be widely integrated" into patterns of care. They are not widely used by patients and practitioners alike despite having the interest. As of April, 31 DTx devices are 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 get through their irritable bowel syndrome and menopause and quit smoking. Last year, Mindset Health raised $12 million in a Series A funding round, which went to expanding the application of its DTx to other medical conditions.