The solutions and the strategy: Telstra Health shows its hand
Hidden among the virtual acres of digital newsprint that have been given over to Telstra's venture into eHealth since it announced its presence two years ago has been the small but persistent question of what the overall strategy behind the company's many acquisitions and partnerships is all about.
Certainly, Telstra Health has made it clear that there are six different areas that it has identified as ones it intends to concentrate on, and the company has never been shy about talking about its plans, but nutting out how this will work in practice has left many an industry observer scratching their head.
Telstra Health itself is aware that it has the industry somewhat perplexed by its various acquisitions and partnerships, good as many of those individual companies are. But in the absence of a new product or service on the market beyond last year's big splash announcing its plans for the ReadyCare telehealth service, it has been difficult to understand what Telstra Health plans to do with them all.
Managing director Shane Solomon admitted as much at the launch of Telstra Health's new MyCareManager solution for aged and community care recently when he said he was often asked what his strategy was.
As a start to finally answering that question, he pointed to MyCareManager, describing it as typifying what Telstra hoped to achieve. It is a platform rather than a simple product, it brings together existing products already under the Telstra banner and it has been designed by one of Telstra's first acquisitions in HealthConnex, formerly DCA Health.
Telstra Health also believes MyCareManager is different from anything else on the market globally. As Mr Solomon said at the launch, MyCareManager “says so much about what Telstra Health is about”.
“In terms of the solution itself, I truly believe that it has the potential to fundamentally transform how services are delivered to people at home, in Australia and I think globally, without sounding too pretentious about it. We have not seen this solution, the combination of this into a single platform, anywhere else in the world. It may exist, I just haven't seen it and we've looked pretty hard.”
MyCareManager brings together a number of technologies in one reasonably simple, reasonably affordable platform. Built on request from community aged care providers such as Silver Chain and RDNS, which have been running several high-profile telehealth pilots involving remote monitoring of and video conferencing with older people at home, the product is notable in that it brings together a number of tried and tested technologies in one platform.
Video conferencing through a tablet with a remote nurse is nothing new, and nor is capturing and monitoring vital signs data and graphing them over time through Bluetooth-enabled medical devices. A personal health record that can be shared with healthcare providers as well as family is nothing new, and while the use of the new interoperability standard FHIR is new, the ability for a technology to interface with care providers' own systems is also something we've seen before.
However, having all of that in one platform, that can be purchased off the shelf and installed out of the box, is new. And the modular structure of the platform, which allows care providers to turn on extra functionality simply through an easily configurable content management system, means it has wide applications, from basic home video conferencing capability for medication reminder programs to physical rehab to full hospital in the home services and palliative care.
The release of the product also gels very nicely with two major government programs: the move to consumer-directed care (CDC) for aged care services and the National Disability Insurance Scheme (NDIS). Telstra Health is already on top of one of the much talked about problems of CDC: providing a monthly accounting of services under the old Home and Community Care (HACC) packages, which has now changed to the Commonwealth Home Support Program (CHSP).
Through MyCareManager's client portal, care providers can share the monthly statement with the client. As community care organisations are the most obvious customer for MyCareManager, this provides a ready-made solution.
The big issues
What this all adds up to is the first solution that Telstra Health has developed that starts to answer some of those six big issues it was set up to tackle.
“Telstra commenced in the health business about two years ago and since that time we have been trying to work out what it is exactly that we should be doing,” Mr Solomon said.
“As we've gone along we have realised that the big issues in health and aged care are issues that are amenable to eHealth interventions and transformation. We've wondered all along why that hasn't happened, why are we so labour-intensive, why are we still doing so many things manually and making so many mistakes inefficiently.
“The reason, we came to realise, is that there are a lot of very good eHealth solutions around the world but they are point-to-point solutions, single solutions. If we are to tackle the big problems in health and aged care then the key to the future is about creating platforms that integrate those different technologies.”
Mr Solomon used the example of a smartphone, which brings together things like the internet, email and maps but combines them on one platform to make something new.
“I think that's the analogy that I'd like to bring to you today about MyCareManager,” he said. “It is all about connecting technologies, bringing technologies together that existed previously, that allows you do something totally new.
“What we've invested in in Telstra and in creating Telstra Health is a range of capabilities. Capabilities around health IT, capabilities around telehealth, capabilities around health analytics and health data.
“So far, Telstra has invested well over $100m in either acquiring, joint venturing or licensing what we think are the best capabilities in Australia and globally so that we can bring together these solutions.
“More than anything, MyCareManager demonstrates, symbolises, illustrates what Telstra Health is all about, our modus operandi, how do we want to do business in the future.”
It also typifies what Telstra wants to do with the subsidiaries it has now collected. In its days as DCA Health, HealthConnex itself was a conglomeration of different capabilities and companies, including aged and disability software TCM, secure messaging service Argus, clinical care software in Communicare, electronic messaging and rostering with ConnectingCare, and Victoria's Human Services Directory, which has been adapted for the National Health Services Directory (NHSD).
Mr Solomon said the strategy for purchasing or partnering with these sorts of firms was not just to accumulate a bunch of companies.
“The whole idea is that there are capabilities to build, to support, to market these products,” he said. “[HealthConnex MD] Peter Young was the first person to see the potential of this and … HealthConnex was able to work constructively to really spec what it was that was needed.
“I think it is a classic example of where Telstra has been able to unlock the capability that has been sitting there. It is a brilliant example of where there are innovative companies in Australia; all they need is to be unlocked and pointed in the right direction of a real problem that needs to be solved.”
Time has come for telehealth
While Telstra has an interest in all aspects of the healthcare system, from acute care to community pharmacy to residential and community aged care, it is perhaps in telehealth that the most immediate application of its might will be felt.
For Mr Solomon, telehealth's time has come, from a provider, consumer and funder's perspective. Telstra is due to launch its much anticipated ReadyCare direct to GP telehealth service later this year, and Mr Solomon believes it is well beyond time that Australia stops looking at the government to fund telehealth pilots and programs and to look far more closely at the business side of telehealth.
Mr Solomon told HISA's Australian Telehealth Conference (ATC 2015) in Sydney last week that in his view, we start things upside down in Australia.
“We are obsessed with the technology and what the technology can do … but the starting point ought to be understanding the value proposition,” he said. “Who are the users, who benefits from this, and once you understand that, the business model flows.”
In telehealth, Mr Solomon said, there are three parties to consider: citizens, providers and funders. For citizens, the value proposition in telehealth comes down to convenience.
“For citizens I think it's a pretty simple thing,” he said. “We talk about fancy things like health outcomes but I think it's just straight convenience. That is what technology brings, straight convenience, and we shouldn't be ashamed of it.
“The only thing we don't have a lot of is time, and if I don't have to spend time sitting in a waiting room in my doctor's surgery reading New Idea, you have given me some of my life back. It is convenience and maybe its about managing your own health as well.”
Telehealth can provide that convenience, but will consumers pay for it? Mr Solomon believes they will, as do an increasing number of people involved in telehealth, including the three people who joined him on a panel discussing the "Uberfication of telehealth" at ATC 2015 – US-based entrepreneur Ron Gutman, who has made a thriving business called HealthTap based on convenient access to healthcare information and to doctors, and who has just launched an app for the Apple Watch that lets a consumer speak directly to a doctor through the watch; Tasmanian GP and the brains behind the GP2U service, James Freeman; and David Cross, health analytics manager from health insurer Bupa.
Mr Solomon said consumers usually took convenience for granted but there were examples of where they were happy to pay for it, and Mr Gutman's HealthTap business is just one example. Telstra Health itself investigated a concierge model of telehealth in the US that has grown from 30,000 to 550,000 customers in six years, he said.
The model for paying for that concierge is simple and is one that Telstra is uniquely geared up for: paying a monthly subscription to the health service as part of your monthly phone bill.
“Obviously that is of interest to Telstra,” he said. “We are used to paying something if we believe we get some direct benefit from it. I think there are models for citizens where they will pay for convenience. I'd certainly pay $40 out of pocket to get my repeat prescription if it meant I didn't have to sit in that bloody waiting room.”
For healthcare providers, he believes there are two drivers behind eHealth and telehealth: one is to make life easier by automating boring or repetitive tasks, and the other is through increasing productivity, and therefore earnings.
He used the example of two companies Telstra Health has purchased: online appointments booking service HealthEngine, and radiology messaging system Medinexus. For the former, GPs are willing to pay for the service as it enables them to fill more slots in their day that would otherwise be wasted, while for the former, radiologists are willing to pay to send imaging results to GPs for free as it helps them keep and gain new referrals.
For funders, the answer is simple: saving money. “If you think of public funders or private funders, they both want to save money,” he said. “They both haven't got enough money to cope with the demand they have got.”
For public funders, obvious models include those used by Canada's Ontario Telehealth Network, which uses s simple subscription model and the government pays for the public sector. A more radical model could be an approach to a state government like Queensland, for example, which spends millions every year on patient transport.
If a company could provide technology for free to reduce that burden, could it then share in some public funding?
According to Mr Solomon, technology has to be able to help achieve value, and it needs to do this in three ways.
“One is that it should be easy to use,” he said. “A lot of the failure to use and adopt technology is that we fail to make it easy to use. Good technology is intuitive and you can just use it.
“Secondly, it is affordable. It is not a pilot that is unsustainable – it's built cheaply and is able to be fitted into the mainstream health system. And thirdly, it is about an integrated open platform. I am very interested in [Mr Gutman's] platform because it links telehealth with patient information.
“Patient information is the enabler of telehealth. It's not just a video connection – it's a whole collection of stuff around it. We are very excited about what we are doing in Telstra Health to try and create some of those platforms. It is a very exciting time to be in telehealth.”
Posted in Australian eHealth
Tags: Telstra Health