How can economics help determine the feasibility of the Advanced Allied Health Practitioner-led Model of Care?

Models of Care in the public healthcare sector prioritising low-cost community settings can transform public healthcare. Models of Care that embed Advanced Allied Health Practitioners often provide low-cost healthcare. In recent conversations with Local Health Networks, our experts have heard about the benefits of Advanced Allied Health Practitioners in community care, as discussed in this article. This becomes even more relevant as our society ages, where the elderly would often present to the emergency department (ED) or hospitals with back pain, falls, or age-related conditions. Hence, we need more Advanced Allied Health Practitioner-focused Models of Care, and that’s where economics can help.

Evidence of Advanced Allied Health Practitioners in Hospital Avoidance Clinics lowering healthcare costs 

Health issues such as low back pain, falls and geriatric syndromes can often be treated at a Hospital Avoidance Clinic practice by Advanced Allied Health Practitioners. Sometimes, a single discipline, such as physiotherapists or a podiatrist, would be enough to treat a pathway, and sometimes, a multidisciplinary team comprising of nursing, medical and other Advanced Allied Health Practitioners, including occupational therapists, psychologists and social workers, would be required. Even so, the cost of treating patients in the community in Hospital Avoidance Clinics is lower than if patients presented at a hospital or ED.

Various allied health-led programs across Australia and overseas have demonstrated significant benefits in healthcare. In New South Wales, the Rapid Assessment, Intervention, and Discharge-Emergency Department (RAID-ED) model resulted in a reduced length of stay, as demonstrated by an average inpatient bed day savings per patient of 1.65 and bed day cost efficiency due to a decrease in patient average length of stay by $310,200 by utilising a multidisciplinary team in the ED. The United Kingdom's Frailty Assessment Base (FAB) team prevented over 250 hospital admissions in six months. Australia's Early Detection of Deterioration in Elderly residents (EDDIE) program focused on early detection in aged care facilities, reducing hospital admissions by 19 per cent. In Canterbury, New Zealand, community-based services helped control ED attendance and acute admissions. The My Home Hospital (MyHH) virtual model in South Australia showed reduced hospital-acquired complications, high patient satisfaction, cost savings, increased hospital capacity, and improved health outcomes through personalised care. 

In South Australia (SA) the Commission on Excellence and Innovation in Health (CEIH) proposed a community based model of care for low back pain, focusing on timely, evidence-based interventions and person-centred care. This model aims to reduce hospital costs, admissions, ambulance ramping, and patient wait times, improving outcomes for consumers and the healthcare system. 

Why economics? 

Motivated by the need to explore cost-effective ways to improved flow through the healthcare system, the Allied and Scientific Health Office (ASHO) within SA Health evaluated the effects of introducing specific Advanced Allied Health Practitioner roles in Hospital Avoidance Clinics as either new or existing care models in SA’s public healthcare system. Our Economics team examined the practicality of a statewide model focused on Advanced Allied Health Practitioner. The complexities of the health systems, along with socio-economic issues and the need to utilise the full capability of experienced staff, necessitate investment in innovative care approaches. A feasibility study helps pinpoint opportunities and challenges in implementing these models and assesses whether the resulting impact provides the anticipated public value. 

In a feasibility study, the role of economics blends creativity, skill, and a grasp of the relationships among stakeholders while collaborating with health service providers and using economic analysis tools like Cost-Benefit Analysis (CBA). Economics is vital for achieving effective results throughout healthcare service delivery, from the feasibility study phase to implementation and beyond. 

Challenges confronting a feasibility study of a concept Model of Care 

Conducting an economic analysis for a concept model of care presents challenges due to limited data and the need for accurate assumptions. While estimating establishment costs is straightforward, identifying and monetising benefits is complex, requiring stakeholder engagement and co-design of data collection tools. Collaborative discussions with clients are crucial for validating benefits in a CBA. 

A key element of CBA involves establishing a baseline case and a program case to create ‘with intervention’ and ‘without intervention’ scenarios. If a target population for these scenarios is hard to identify, quasi-experimental design techniques may be necessary. As economists, we can utilise literature reviews, public hospital data, and interviews with health professionals to gather the required data. 

Case study: Feasibility study of a Model of Care with Advanced Allied Health Practitioner roles in Hospital Avoidance Clinics 

As our society ages, more people in the community will require support from Advanced Allied Health Practitioners to maintain function and quality of life and the demand on healthcare services will grow. However, a feasibility study of an Advanced Allied Health Practitioner-led Model of Care within a Hospital Avoidance Clinic would require identifying the costs and benefits of such a model.

Identifying costs and benefits 

We identified the types of costs and benefits of introducing Advanced Allied Health Practitioners in Hospital Avoidance Clinics with a Local Health Network case study informing the assumptions for a statewide CBA.

Some of the benefits identified for the health system, included: 

  • Less ED attendance and reduced hospital admissions and readmissions 
  • Reduced length of stay at hospitals 
  • Cost savings through direct referrals to Advanced Allied Health Practitioners
  • Improved patient flow through the health system, reducing delayed transfer of care 
  • Enhanced efficiency in EDs. 

The benefits identified for individuals, included: 

  • Hospital avoidance and improvement in quality of life through community-based care 
  • Improved functional independence and recovery 
  • More appropriate care through targeted interventions 
  • Improved access to care through virtual models 
  • Enhanced quality of life 
  • Improved mental health.

Defining scenarios and economic analysis 

ASHO's pathways model illustrated current ED pathways and an alternative model using Advanced Allied Health Practitioner roles in a Hospital Avoidance Clinic, aiding our experts in designing scenarios for a CBA. The CBA included seven health issues treated by four types of Advanced Allied Health Practitioners, with some requiring a multi-disciplinary team. The CBA includes establishment, ramp-up and operating phases.

Costs estimates were triangulated using simultaneous top-down and bottom-up approaches. While not all benefits could be quantified, most were reported as cost savings from diverting patients from ED and hospital stays to Advanced Allied Health Practitioner-focused Hospital Avoidance Clinics. Indirect benefits, including improved patient flow and quality of life often exceed direct benefits such as hospital avoidance.

We calculated two main types of benefits/cost savings: 

  • Cost savings from diverting consumers away from ED 
  • Cost savings from diverting consumers away from public hospitals. 

Key results

  • A focused model of care was expected to divert 32,000 presentations to Hospital Avoidance Clinics across SA, with the majority of the cost savings attributed to ED avoidance and hospital avoidance 
  • $65 million annual cost savings from employing 26 Advanced Allied Health Practitioner roles in SA; this is equivalent to $2.5 million worth of benefits per Advanced Allied Health Practitioner full-time equivalent per year 
  • An indirect benefit expected from diverting patients away from hospitals to Advanced Allied Health Practitioner-focused Hospital Avoidance Clinics is the improved flow of services within the healthcare system, reducing delayed transfer of care 
  • The proposed model of care has a benefit-cost ratio of 1.8, indicating that for each $1 of cost, $1.8 is expected to be returned to the SA community in benefits 
  • The CBA of Advanced Allied Health Practitioner-focused Hospital Avoidance Clinics in SA found a net social benefit, supporting the case for continuing to develop this model of care. 

How BDO can help? 

Our economics team comprises individuals who understand public health systems and health projects, are experienced in stakeholder engagement in public health, and have the expertise to recommend and develop appropriate economic assessment methods. 

We are well-versed in cost-benefit analysis, cost-effectiveness analysis, economic impact analysis, cost-of-illness studies, and qualitative benefit assessment.

We can help you with your feasibility assessment, business case preparation, and program evaluation. Contact us to discuss your next project.