In our second article on technological innovation, we explore the growing use of Telehealth and how it is being used to help solve the challenges of mental health claims across regional, rural and remote Australia.
Mental illness has become a significant worldwide health issue in recent years according to the World Health Organization1 with health data showing that most people with mental illness remain either untreated or poorly treated2.
In a News.com.au article, ‘Growing mental health issues spark surge in insurance costs and claims’3 published in March 2017, it notes that roughly one million Australians suffer depression and two million suffer anxiety and despite two decades of investment in improving mental health services, the mental health of Australians has not improved.4
Insurers are feeling the impact of this with data showing mental health claims payouts are now the equal largest for income protection insurance policies. 3
This article quoted TAL Life insurance, noting “it paid out $185 million in mental health claims last year — second only to cancer in terms of total life insurance payouts, and separate insurance company data shows that for income protection — where most depression and anxiety claims surface — mental health related payouts are running neck and neck with accidents and injury, and are twice as high as cancer payouts.”3
Financial analysts say “insurers were unprepared for the growth and rising awareness of mental health issues in recent years, and consumers are paying the price through higher premiums and tougher rules.”3
This upswing in mental health claims has impacted the profitability of many insurers in the Income Protection space who, due to the increased duration of claims, have been required to make greater total payouts. Indeed, the cost of income protection insurance has reportedly climbed more than 80 per cent in four years, and several companies have sold their insurance businesses to global insurers due to the lack of profits.3
The challenge for insurers therefore, is how to improve efficiencies and reduce costs in managing mental health claims.
This article provides an understanding of where particular challenges lie, and discusses the current utilisation and acceptance of Telehealth in the delivery of mental health services where it is needed most. It also discusses how this technical innovation is being utilised within the Life Insurance arena to improve efficiencies and costs associated with managing mental health claims.
Rural Challenges
According to the ‘Mental Health in Rural and Remote Australia’5fact sheet (March 2017), people in regional, rural and remote locations in Australia have a significant disadvantage with all levels of mental health assessment and service. The reported prevalence of mental illness in rural and remote Australia appears similar to that of major cities, however access to mental health services are substantially more limited than in major cities.
Additionally, people in rural and remote areas face a range of stressors unique to living outside a major city. These include a greater prevalence of some chronic conditions and disability, and generally poorer health. Rates of smoking, risky drinking and illicit drug use are also higher. There are fewer employment opportunities leading to lower incomes and less financial security. There is greater exposure and vulnerability to natural disasters, while rates of overcrowding, housing stress, and homelessness are higher.
While the prevalence of people experiencing mental illness is similar across the nation- around 20 per cent, the rates of self-harm and suicide increase with remoteness. This highlights the significant unique mental health issues that need to be addressed in rural and remote areas.
Medical and mental health services are often inadequate in remote geographical areas which often have only a few specialist providers- this compounds the challenges.
In recognition of the critical issues facing regional, rural and remote communities, in January 2009 the Australian Health Ministers’ Advisory Council (AHMAC) tasked the Rural Health Standing Committee (RHSC) to develop a National Strategic Framework for Rural and Remote Health. One of the key objectives of this framework detailed the need to adopt Telehealth applications, Objective 1.3:6
| Objective 1.3 Better health service infrastructure and accommodation, transport and information communication technologies. | · Facilitate developing national standards for patient travel and assistance · Invest in the development of technology and infrastructure tailored for local health service needs · Support the adoption of information and communications technology for local health service needs. |
As a result, there has been considerable work over the past 5 years to develop Telehealth services so as to implement these objectives. The Australian Government has supported the initiative to increase the use of Telehealth for rural and remote Australia, and has expanded this to also include Aboriginal Medical Services and Aged Care Services, regardless of location.
On 1 July, 2011, Medicare and DVA rebates and financial incentives were made available for Telehealth psychiatric consultations7, and in the 12 months to March 2017, Medicare processed over 43,000 telehealth psychiatric consultations, establishing Telehealth as a medical tool that is well accepted by both psychiatrists and members of the public.
Studies have now been completed which demonstrate psychiatric interviews conducted over videoconferencing are reliable for diagnostic assessment and treatment recommendations, and are as effective as face-to-face consultations in achieving improved health outcomes. They have also been deemed a dependable mode of service delivery in routine new referrals8.
So, what is tele health?
In the article ‘One in Four Lives: The Future of Telehealth in Australia’9 Telehealth is described as “the remote management and delivery of health with the potential to improve efficiencies, reduce hospitalisation and improve how healthcare services are delivered.”
This paper notes:
- The models of care in the Australian Health System are unsustainable in their current form
- Telehealth for remote management of healthcare can relieve demand on the system
- Telehealth could be marshalled to play a major role in enabling changes to the service models and delivery required to respond to the growing demand for healthcare in Australia
Today, telehealth can include everything from telephone consultations and live video feeds, digital CT scans and remote monitoring of intensive-care units. Behavioural health, dermatology, radiology, infectious disease and stroke are commonly covered service lines, and primary-care services are becoming a major focus, since they usually involve quicker diagnoses.
The huge growth expected in the telemedicine market is mainly due to the potential of telemedicine to revolutionize healthcare delivery as we know it. Telemedicine makes it possible to instantly deliver healthcare at any time to and from anywhere in the world.
In Australia, videoconferencing plays an important role in Telehealth initiatives because it provides a cost-effective means of delivering medical and mental health services that are often inadequate in remote geographical areas. Importantly, it reduces the need for mental health patients to travel great distances to get the treatment, support and advice they need.
Because of the increased acceptance and utilisation of Telehealth within Australia, the RANZCP has developed ‘Professional Practice Standards and Guides for Telepsychiatry’10.
These standards include considerations around informed consent, collaboration, ethical principles, confidentiality and privacy of health information, and safety and quality.
Application of Telehealth within the Life Insurance Sector
With such technological innovation being widely accepted as a valuable tool in the diagnosis and treatment of mental health issues not just within Australia but globally, it raises the question of using telehealth as a tool in the management of mental health claims. In the same way that the volume of mental illness and its geographic spread makes the models of care within the Australian Health System “unsustainable in their current form”9, so too, Life Insurers need to look for innovative, cost effective ways to better manage mental health claims and improve their associated health outcomes.
Video-conferenced medical expert assessments
Psychiatric Telehealth medico-legal assessments are now a mainstay of the medicolegal sector, with many thousands of assessments conducted using this technology each year. Because videoconferencing can occur in any location that has the internet, they have rapidly become a preferred way to manage regional, rural and remote claims.
How are consultations conducted?
The technology used for telehealth assessments is of vital importance to the quality and success of the consultation. There has been a big shift away from using the Skype technology commonly used by legacy providers. State of the art, cloud-based technology is now available which offers strong, robust connections that minimise drop-outs, provides high video quality imaging that makes facial movements crystal clear, and a host of sophisticated tools that enables the latest medical information to be exchanged on-demand using secure, encrypted technology.
Claimants can undertake their psychiatric assessment at whatever location you choose- even at their home, where they are more likely to be calm and more cognitively astute.
Consent forms can be electronically signed, using sophisticated signature technology, and the consultation is commenced when both claimant and medical expert have clicked on their unique appointment link. What could be easier than that?
The advantages of using telehealth for Psychiatric medicolegal assessments are numerous:
- Get an appointment sooner: There’s no need to wait months to complete a psychiatric assessment in a regional, rural or remote location. Psychiatrists can perform assessments wherever they are located, without the need to travel to a specific
- Reduce Costs: Less client travel and faster turn-around times enables you to reduce your claim management costs.
- Speak to the Psychiatrist: You can talk to a specialist before or after the assessment, keeping communication open and clear.
- Improved member experience: Conduct highly professional and efficient assessments in locations convenient to your client.
- Reduce non-attendance:The convenience of local assessment centres reduces the frequency and costs associated with non-attendance. Your client will receive SMSs, Google Maps and a checklist to prepare for their virtual interview.
- Quality standards:With rapid advances in videoconferencing technology created by leading researchers such as the CSIRO’s COVUI, videoconferencing now meets strict Australian standards around the protection of health records and current Privacy laws.
References
- What about Telepsychiatry? A systematic Review. Garcia-Lizana F, Munoz-Mayorga I. Prim Care Companion J Clin Psychiatry. 2010; 12(2): PCC.09m00831. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911004/#bib1
- A proposed e-care center for mental health interventions, Kao SC, Lin CE, Chiu NY.. J Psychiatr Pract. 2006;12(3):180–186.
- Growing mental health issues spark surge in insurance costs and claims, com.au, March 27th2007 http://www.news.com.au/lifestyle/health/growing-mental-health-issues-spark-surge-in-insurance-costs-and-claims/news-story/48a73718c679a14ccd8f63af4255084c
- http://ruralhealth.org.au/sites/default/files/publications/nrha-mental-health-factsheet-2017.pdf
- The National Strategic Framework for Rural and Remote Health was endorsed by the Standing Council on Health at their meeting on 11 November 2011 https://www.google.com.au/search?q=The+National+Strategic+Framework+for+Rural+and+Remote+Health+was+endorsed+by+the+Standing+Council+on+Health+at+their+meeting+on+11+November+2011&oq=The+National+Strategic+Framework+for+Rural+and+Remote+Health+was+endorsed+by+the+Standing+Council+on+Health+at+their+meeting+on+11+November+2011&aqs=chrome..69i57.414j0j7&sourceid=chrome&ie=UTF-8
- http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp
- RANCP: Professional Practice Standards and Guides for Telepsychiatry https://www.ranzcp.org/Files/Resources/RANZCP-Professional-Practice-Standards-and-Guides.aspx