(This article first appeared in the Australian Financial Review)
At the start of last year Michelle, an audiologist in Melbourne’s outer eastern suburbs, felt her anxiety and depression flaring up after several years of having had it under control.
Five years into her career, she had taken on more responsibility at her clinic. She was becoming “very, very anxious” and suffering from initial physical symptoms – but not the crippling panic attacks during her master’s degree in audiology in about 2009.
Back then, due to anxiety over things like assessments, she would be immobilised in her bedroom, with difficulty breathing and having to lie down and wait the symptoms out. She wasn’t absent from university, but her work was affected, she says.
The health system has struggled to cope with untreated mental health conditions, which are estimated to cost the economy about $11 billion a year. Six million days are lost to depression each year and more than 3 million Australians suffer disabling stress, worry, anxiety, low mood and depression.
Finding more effective ways to treat chronic disease is the Holy Grail of healthcare, which costs more than $155 billion a year-about 9 per cent of GDP – in Australia. Public systems have been slow to move despite countless reports urging them to do so.
Mental health imposes the second largest burden on the community after cardiovascular disease, equal to injuries and larger than respiratory diseases and cancer. Australian Unity is talking to more partners – rival insurers and employers -and targeting more conditions for a similar approach.
Around the time Michelle’s symptoms recurred a year ago, her employer emailed staff about a telephone coaching service for staff with certain health conditions, including anxiety and depression. It was provided by Remedy Healthcare, part of Australian Unity.
The insurer was alarmed at the growth in claims a decade ago, especially for chronic diseases. It cast about for programs to slow mental health claims growing at 15 per cent a year.
Remedy’s MindStep program, adapted from one used by Britain’s National Health Service, targeted anxiety and depression and has proved so successful in its first year that Australian Unity is planning to widen its embrace to post-traumatic stress disorder, pain management, post-natal depression. Amanda Hagan, head of health, would also like to tackle youth mental health.
Michelle got in touch with MindStep and – after a few getting-to-know-you emails and a history-taking session – had her first coaching session.
Coaches are not qualified psychiatric professionals but come from allied health fields and receive 12 months’ intensive training, paid for by Remedy. They follow a structured program and are supervised remotely by clinicians who scan transcripts of coaching sessions and refer anyone showing acute symptoms-such as thoughts of suicide – for immediate help.
Michelle’s coach explained how anxiety manifests in physical and emotional symptoms, and over the course of subsequent “meetings” -weekly, and then quarterly-they worked out some goals for Michelle to pursue.
One was simply to be sure to catch up with friends once a week -to try to get out of the habit of becoming a “recluse” whenever she became anxious or depressed. A second was just to keep her house clean. Michelle lives by herself in a unit, and wanted to be able to take pride in her home even during bouts of anxiety and depression.
By the time Michelle finished with MindStep in October, she had discovered a lot of things that triggered her anxiety, such as worrying about things that were outside her control.
Her coach gave her tools for coping, such as recognising when she is worrying about things unnecessarily, and nipping them in the bud before they become more serious.
“I still have my moments when I get a bit stressed but I recognise those moments earlier than I did and I am able to deal with them better than before,” Michelle says.
“I am happier than I was a few years ago and happier than I was at the start of the year . I am able to work more productively and get back to whatever it was that I was doing before those stresses came along.”
For Australian Unity, results are also pleasing. Three-quarters of those who have been through MindStep report an improvement, and 55 per cent show no clinical signs of anxiety or depression.
Claims costs have fallen $7800 per person per year for the cohort, and average days in hospital and readmissions are sharply down. The insurer has saved $4 million in the first year of the program.
If it can replicate these gains more broadly, we may just make a dent in the $155 billion healthcare bill.
Ben Potter (2016, January 10) Step to remedy mental health The Australian Financial Review Retrieved from http://www.afr.com.au
Photo: Josh Robenstone
Remedy Healthcare can now accept referrals directly on our website. Our online form is quick and easy to use, allows you to attach other documents, and saves time on hunting for paper forms! Hospitals, GPs and medical professionals can refer patients to Remedy online for the following programs:
• Hospital Care at Home
• Rehab at home
• Specific Allied Health brokerage services
Our electronic form is protected so your patients’ information is safe and secure, and each referral is managed by our care-coordination team just like our paper referrals.
You can find the form here or you can navigate to the form at the top of the page by clicking on the “Refer” link.
On Thursday 12 November, Remedy Healthcare officially launched a new mental health program ‘MindStep’ that will assist individuals currently presenting at acute hospitals with anxiety and depression to access additional mental health services and support to help them once they are discharged.
Olympic gold medallist Matthew Mitcham, who has battled with depression and anxiety throughout his career, participated in the official launch and provided a candid account of his experience.
“So many people don’t feel strong enough to reach out just because of the stigma around mental health. The more we talk about it, the more we will break down the stigma. A lot of great things have been done in the mental health space to tackle depression and anxiety but I still think we need to talk about it more,” Matthew said.
The MindStep program is the first of its kind to be launched in Australia to target people discharged from hospital. It is an adaptation of the Improving Access to Psychological Therapies (IAPT) model. This model has been successfully applied in the United Kingdom health system since 2008 and more recently in Flinders Medical Centre in South Australia.
Remedy Healthcare General Manager David Brajkovic said MindStep will be the first application of the IAPT model for post hospitalisation related clinical depression and anxiety.
“MindStep is the culmination of considerable time and resource investment in researching evidence-based mental health models that can be applied to all aspects of the Australian healthcare context,” Mr Brajkovic said.
“Despite its incredible prevalence, mental health continues to be an area that suffers from severe government under-funding. Sadly, this reality is compounded by the fact that people with clinical depression and anxiety who are admitted to a mental health facility are, on average, staying for 20 days or more.
“Once this begins, patients often bounce in and out of these facilities because there are very few services available to assist them—and GPs are often under resourced, or have few options for referral to community-based services to support them,” Mr Brajkovic said.
Remedy Healthcare identified that while the knowledge and awareness of mental health issues has undoubtedly increased in the past decade, there existed a shortage of measurable programs that would help people recover and reduce the need for them to go to, or back to, hospital. There has until now been a major gap in services.
“Finally, in 2011 we started to see evidence of the success of a program in the United Kingdom called Improving Access to Psychological Therapies or IAPT. Importantly for Remedy, the IAPT program followed a very similar model to the already well-established chronic disease management model in Remedy,” Mr Brajkovic said.
Mental health program research outcomes:
MindStep is a stepped model of care delivered telephonically by Remedy coaches supported by materials available online over a period of 6-8 weeks. The program can be delivered to anyone anywhere in Australia and helps fill the current gap between the GP, the mental health specialist and acute care.
Remedy has partnered with York University in the UK who developed the materials and the system, and Flinders University in South Australia who provide the clinical training for Remedy’s coaches as well as clinical oversight of each and every case.
Remedy Healthcare would particularly like to acknowledge the assistance of Professor Malcolm Battersby at Flinders University who played an integral role in bringing MindStep to life.
Eight Australian private health insurers have already formalised their involvement in the program: Defence Health, Australian Unity, Grand United Health, nib, GMHBA, Teachers Health Fund, Peoplecare and Health Partners.
“We plan to take this program into both the private and public health sectors. Further, we will be encouraging the general public to refer people they know to be suffering from anxiety or depression to the program and to help spread the word that there is now an alternative approach for people suffering from anxiety or depression,” Mr Brajkovic said.
Remedy Healthcare has acquired physiotherapy business, Physio Connect. This transaction took place in March 2015.
Remedy Healthcare General Manager, David Brajkovic, said this acquisition marks an important milestone in the company’s evolution and accelerates its plan to expand allied health business into aged care.
“With the inclusion of Physio Connect, the Remedy business now has real momentum with a platform to extend our service coverage into aged care and hospitals alongside already established programs in care co-ordination, home-based rehabilitation and health coaching.”
Physio Connect‘s physiotherapy and allied health services extend to a number of aged care facilities across Victoria and New South Wales. Its expertise in the aged care sector covers manual handling education, podiatry and pain management, on top of its physiotherapy offering. The business will bring over 20 new staff members to the Remedy team.
The two owners of Physio Connect, Travis Hampson and Joel Johnson, will take on strategic roles at Remedy to oversee the transition and to assist in the future growth of the Remedy client base, programs and services in the aged care sector.
“The acquisition of Physio Connect (and integration with Remedy Healthcare) presents us with great opportunities for the brand and its clients,” the pair said in a joint statement.
“Our integration is well underway and our customers have been more than happy with the continued level of service. The Physio Connect team is excited about expanding its customer base under the Remedy brand,” the pair said.
Mr Brajkovic said the purchase of Physio Connect is a likely precursor to follow-up acquisitions in the aged care space.
Remedy Healthcare has purchased South Australian home-based physiotherapy business, Mobile Physio.
Remedy Healthcare General Manager, David Brajkovic, said this milestone allows the business to extend its care service coverage into community settings, aged care and hospitals throughout South Australia.
“Remedy has been actively seeking to build a direct care team and this acquisition will enable a number of new opportunities for Remedy and our customers in South Australia,” Mr Brajkovic said.
“The inclusion of Mobile Physio allows Remedy to leverage this remote team across the broader Remedy program suite in care co-ordination, home-based rehabilitation and health coaching.”
The purchase of Mobile Physio adds over 12,000 extra patient visits per year, providing physiotherapy services to older people living in their own homes.
Jake Gilbertson, the previous owner of Mobile Physio, says coming together with Remedy Healthcare represents, at its core, a recognition of shared values in providing ‘patient first’ community care.
“Our philosophy is to promote and support our clients’ wellbeing through education and intervention aimed at maximising independence, thus enabling a person to return to, or remain, living safely and comfortably in their own home and community,” Mr Gilbertson said.
“Remedy Healthcare and Mobile Physio both recognise the importance of supporting our staff, our partners, and the broader healthcare market in order to deliver on our shared philosophy. Together, we hope to continue to grow our business, both in scope and quality, while maintaining an efficient, cost-effective and reliable homecare service.”
Mr Gilbertson will become part of the Remedy team in South Australia and oversee the day-to-day service delivery in the region.
Remedy also recently finalised the acquisition of Physio Connect, with expertise in the aged care sector covering manual handling education, podiatry and pain management, on top of its core physiotherapy offering.
The purchase of Physio Connect and Mobile Physio brings Remedy’s team to over 120 nationally. In addition to Remedy’s 32 health insurance customers, various corporate customers and 150 hospital referrers, the business’ customer base will now extend to over 25 aged care sites.
Mr Brajkovic said Remedy Healthcare will continue to pursue other strategic business acquisition opportunities in the health and aged care sectors Australia-wide.