Enhancing digital healthcare: aligning Australia’s digital health strategies with value-based healthcare principles
Paul Tait

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Abstract
This appraisal aims to map Australian digital healthcare strategies at the territory, state, and national levels, utilising a value-based healthcare (VBHC) framework to identify key processes in building value into digital health initiatives.
The researchers conducted an Advanced Google search to identify strategic frameworks relevant to delivering digital healthcare solutions. They screened documents based on set inclusion and exclusion criteria. Using Braun and Clarke’s approach to thematic analysis, the researchers mapped the contents of the strategic digital health documents against a published VBHC framework to identify 10 common key processes for embedding VBHC into digital health initiatives.
The strategic documents collectively align with VBHC. In mapping these documents, this review identified 10 key processes organisations delivering digitally based healthcare services can use to integrate VBHC into digital healthcare services. Additionally, the review highlighted two gaps in the strategic documents that could enhance their alignment with VBHC principles. First, to address the health inequities that certain groups face, it is essential to explore how priority populations connect with virtual care services. Second, a national approach must be undertaken to develop patient-centred outcomes and experience measures to demonstrate how digital health innovations improve service effectiveness and accessibility.
In mapping the digital strategies against a published VBHC framework, we have identified 10 key processes for embedding VBHC into new digital health innovations. Strategic documents must advocate for building digital health innovations that consider priority populations and foster patient-centred measures that enhance effectiveness and accessibility.
Keywords: digital health, health system, key and priority populations, policy, policy levers, telehealth, telemedicine, value-based healthcare, virtual care.
Introduction
Australia’s healthcare system is constantly evolving – driven by many challenges, including an ageing population, digital disruption, and rising costs.1 Frow et al. employs the term ‘health service ecosystem’ to describe the complexity underpinning healthcare delivery and its evolving nature.2 An ecosystem incorporates multiple aspects of healthcare delivery throughout primary, aged, and acute care within the broader policy and technology landscape.3–6 Ecosystem-wide, digital health provides an innovative approach to complement face-to-face services; it offers the consumer access, choice, and convenience.7 Digital health encompasses various technologies and approaches, including artificial intelligence, big data, electronic health records, smart device applications, telehealth, virtual care, and wearable devices.8 As governments face pressure to create scaled economies through digitisation, they risk compounding the challenges inherent in the ecosystem.9
In Australia, determining how to allocate limited healthcare resources is a concern that affects all levels of government – territorial, state, and national.10 Strategic documents created by government and peak bodies aim to unite all stakeholders around a common goal: developing and delivering services within finite resources. While they do not directly change behaviours, they aim to emphasise values and perceptions, crucial for driving change throughout the ecosystem.
Governments globally – including those in Australia – are prioritising value in response to increasing demands on delivering healthcare.11–13 Value-based healthcare (VBHC) provides an approach that considers challenges inherent across the ecosystem by prioritising investment against consumer needs.14 Hurst et al. define VBHC as the ‘equitable, sustainable and transparent use of the available resources to achieve better outcomes and experiences for every person’ (p. 8).15 Critically, research supports this, showing that organisations implementing VBHC improve outcomes and reduce costs through better resource allocation.11,15,16 Tiesberg and colleagues’ published framework describes five VBHC domains (see Table 1).14
VBHC domain | Description | |
---|---|---|
Understand the shared health needs of patients | The model starts with organisations identifying and understanding specific groups of patients whose health conditions and circumstances create a consistent set of needs. | |
Design solutions to improve health outcomes | Organisations then must design and deliver a comprehensive solution to address those needs. | |
Integrate learning teams | To do this, organisations need to equip these integrated teams with systems that assist with continuously learning about the system within which they are working. | |
Measure health outcomes and costs | This integrated team measures significant health outcomes from the care provided to each patient and the costs associated with its services. | |
Expand partnerships | As health outcomes improve, evidence of better care enables the team to expand its reach by serving more patients through new partnerships. |
This appraisal maps Australian territory, state, and national digital healthcare strategies against Tiesberg and colleagues’ VBHC framework to identify processes for integrating VBHC into digital initiatives.
Methods
A document review was conducted leveraging Advanced Google to identify digital strategic plans for healthcare delivery in Australia at the territory, state, and national levels. The leading search terms were ‘virtual,’ ‘telehealth,’ or ‘telemedicine’, combined with ‘strategy,’ ‘strategic,’ or ‘blueprint.’ The researchers limited the search results to Australia and portable document format (PDF). All documents were screened to ensure they were relevant to healthcare.
Inclusion criteria included documents that: 1) focused on digitally delivered healthcare services, and 2) were created at a territory, state, or national level.
As digital health is sensitive to time and context, the exclusion criteria included documents published before 2019.
Two researchers with different professional backgrounds reviewed a draft list to ensure all selected items were relevant to the study. The project lead then imported the finalised list into NVivo 14 software for coding and analysis, following Braun and Clarke’s approach to thematic analysis in four broad steps.17
First, both researchers familiarised themselves with the included strategic documents, taking high-level notes while considering any gaps and tensions between the different documents. Second, they identified concepts in the form of passages of interest from the strategic documents, which the researchers categorised as codes. These passages varied in length, ranging from phrases to short paragraphs. Third, the researchers mapped each code against Tiesberg et al.’s published five domains, to evaluate how the strategic documents align with a VBHC approach.14 Finally, within each of Tiesberg et al.’s domains, the researchers divided the codes into two subthemes, which resulted in 10 key processes over the five domains.
Ethics approval was not required as this review focused on published documents.
Results
The search identified 25 strategic documents. After screening for inclusion and exclusion criteria, the researchers selected 14 for the review. Fig. 1 provides the study flow diagram. Table 2 shows details of the strategic documents, including their name, year of publication, jurisdiction, and organisation. Five documents covered national jurisdiction, while the remaining nine covered territory or state jurisdictions. Only one state did not have a published state-wide strategy. The analysis identified 10 standard key processes in building the VBHC principles into digital health initiatives (see Fig. 2). In what follows, we present 10 key processes with examples from strategic documents that illustrate their connection to VBHC.
ACT, Australian Capital Territory; AHHA, Australian Healthcare and Hospitals Association; AIDH, Australasian Institute of Digital Health; NSW, New South Wales; NALHN, Northern Adelaide Local Health Network; NT, Northern Territory; SA, South Australia; WA, Western Australia.
Understanding challenges in providing in-person healthcare services
As populations age and multimorbidity increases, the demand for in-person health care has grown, requiring greater investment, especially for those with chronic conditions.18,21,25,26,28 This situation pressures local healthcare services regarding how they deliver face-to-face services and creates issues for individuals accessing services. For instance, those with multiple and complex needs can struggle to navigate services and often find themselves retelling their medical history at each encounter.21,23
This problem is especially significant for specific groups, such as individuals in rural and remote areas and Aboriginal and Torres Strait Islander communities, who prefer to stay on country where possible.22,25,26,28,31 These populations face disparities in alcohol consumption, smoking, and obesity, while access to specialist and community healthcare services is often limited. Indeed, for some, staying at home can lead to better health outcomes by preventing functional decline, infection, and social isolation.29 To overcome these disparities – contributing to poorer health outcomes – some strategies suggest approaches that improve the coordination of service delivery for these populations.22,31
Identifying barriers in the population navigating digital platforms
While the strategies highlighted the benefits of integrating digital health innovations to address various challenges in delivering care within the healthcare ecosystem, the review also identified common barriers to accessing and providing digital healthcare. These barriers include concerns about data security, a lack of consumer trust, and the users’ ability to navigate digital tools effectively.18–31 Indeed, one strategy attempted to quantify this last point by stating that 1 in 10 Australians is not online.18
The documents described the ability to understand health information or use digital tools effectively using terms such as health literacy, digital literacy, and digital exclusion.18,21,22,28 Digital exclusion is significant among certain groups when considering access, affordability, and digital skills. This includes individuals who have not completed secondary education, those aged over 75, people with lower incomes, individuals who live alone or in public housing, those with disabilities, and those who are unemployed or not part of the workforce.22 While digital solutions can improve ecosystem access, they can increase disparities if technological challenges create barriers.23
Embedding evidence-based care into usual practice
Healthcare delivery is a dynamic field, constantly evolving as new evidence-based practices emerge. Evidence-based practice involves using the best current evidence to make informed decisions about individual consumer care.18,21,31 Yet, with emerging fields such as the implementation of virtual services, the published literature will identify knowledge gaps. As such, when writing new policies or designing new digitally based healthcare services, reflecting on how they can inform the evidence is essential. Just as understanding the evidence is necessary, organisations developing new virtual care models should also contribute to the evidence base by sharing learnings.
Incorporating co-design principles
Involving consumers and clinicians in co-design is vital for effective virtual care models. This approach is more than a formality; it is essential for integrating people, processes, and technology to enhance trust in care delivery.20,23–25 The emphasis on collaboration among all stakeholders ensures that solutions are customised to meet the diverse needs of populations, including Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse (CALD) communities, individuals who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ), as well as geographically dispersed populations.22,24
Investing in skilled facilitation, evaluation, and feedback mechanisms allows for quick testing of new designs and effective engagement between communities and service providers.23 Early and ongoing engagement with consumers helps define their needs and builds trust in digital health innovations.
Integrating continuous learning
Focusing on continuous improvement that emphasises learning from successful and unsuccessful approaches encourages the team to develop innovative practices. Indeed, the strategies outlined explain how clinicians gain knowledge through their clinical experiences, which can enhance patient outcomes and ensure that digital health innovations are scalable and sustainable.20,25,27–29,31 Furthermore, the ability to learn and adapt locally will be crucial as digital health supports more healthcare professionals to work outside traditional settings, potentially in less structured environments.28 However, these skills are not inherently present in all healthcare professionals, and organisations must invest in their workforce to develop and nurture a learning and improvement culture.31
Building clinical governance structures
Just as a culture of continuous learning is critical at a clinical level, Australia must have the necessary policies, regulations, funding, and governance to encourage collaboration and drive innovation more broadly.20,22,23,28 Strategies described the need for reviewing current policies, including agreed standards and governance systems, to embed digital safeguards to encourage investment, development, and innovation in digital health. This exchange between clinical learnings at the systems level guides and facilitates an ongoing cycle of enhancing safety, quality, and health outcomes.
Improving the quality of the data collected
The strategies emphasise the importance of using high-quality data to make informed decisions at any location and time during the care process, including planning and regulatory activities. The strategies focused mainly on service-level outcomes such as costs, hospital readmission rates, and mortality.21–23,30 These allow governments and organisations to predict necessary changes to address hotspots, meet emerging needs, enhance service delivery, and evaluate the effectiveness of implemented changes.18,23
Interestingly, while the strategies advocated for patient-centred approaches to system design, only one emphasised the importance of collecting patient-reported outcomes and experience measures (PROMs and PREMs).18 Accessing high-quality data from system-level and patient-reported measures is crucial to ensure organisations effectively integrate VBHC into their digital health initiatives; this is essential for accurately assessing the value of fully integrated digital solutions throughout the healthcare journey.
Leveraging digital health utility through data linkages
Large volumes of data generated across different digital platforms can result in inefficiencies when systems are not interoperable. Several of the documents described the importance of system interoperability for enabling clinicians, individuals, and caregivers to access seamless care across a range of services, even when those services use different technologies.18,21,22,26,28,31 It supports real-time information exchange and continuity of care, helping to reduce medication errors, improve data quality, and minimise fragmentation of health information.28
In parallel, the strategic use of linked data plays a different but complementary role. Health systems can build a broader understanding of healthcare needs and patterns by integrating clinical and non-clinical datasets – such as geospatial, socioeconomic, and service utilisation data.22,23,31 This deeper insight supports evidence-based planning for better service access, identifies gaps and disparities in service delivery, and informs prioritisation efforts for effective system integration for those with the most complex needs.23
Supporting access to training, equipment, and infrastructure
VBHC emphasises that organising care around patients with similar needs fosters stronger partnerships. However, the strategies primarily focused on supporting the healthcare workforce. This includes collaboration with training organisations, equipment suppliers, and the necessity for modernised digital infrastructure.21,22,27,29,31 Yet clinicians must also consider the client’s needs regarding how they engage with technology and access infrastructure.28 Although creating digital solutions is attractive to governments as they can lead to overall cost savings, they may also introduce obstacles in access and privacy for pockets of the community.23 Critically, this will require partnerships with organisations such as consumer groups and those not traditionally linked with healthcare delivery, including suppliers of digital technology, biotech, and consumables.28 Digital solutions should be user-friendly, seamlessly integrate with clinical workflows, and be purpose-fit to ensure clinical safety, quality, privacy, and security.22
Building leadership at all levels of government
The government plays a vital role in funding and providing acute healthcare services, but its responsibilities extend beyond that. They establish effective policies, regulations, and governance frameworks encouraging collaboration and stimulating investment in digital health technologies, research, and innovation.23–25,27,31 This support includes developing infrastructure to mitigate cybersecurity risks, ensuring reliable access to data networks, and creating appropriate legislation and policies that address the challenges of a digitally engaged society. The collaborative design of future digital health initiatives among governments, academia, businesses, and industry groups is essential for creating efficient and effective regulations while enhancing accessibility.
Discussion
This analysis examined 14 national and state-based documents that collectively aligned with Tiesberg et al.’s VBHC framework. This alignment is important as VBHC aims to ensure organisations create more value for their consumers. Furthermore, this review identified 10 key processes for incorporating VBHC into digital health initiatives (see Fig. 2), which could serve as a valuable model for measuring alignment. Finally, this review identified two gaps that governments and leading organisations should address when revising or creating new strategic documents: advocating for digital inclusion for specific population groups through co-design and promoting more patient-centred measurement for digital health innovations.
For those developing digital health innovations, it is essential to involve communities at risk of digital exclusion in the co-design process. Evidence shows that co-design is key to creating services that provide real value to consumers.32,33 Policymakers and organisations must find effective ways to connect with these communities.34 While strategic documents often highlighted rural, remote, and Aboriginal and Torres Strait Islander populations, other groups, such as those from CALD and LGBTIQ communities, were frequently overlooked. This raises the question of whether Australia should establish a consistent list of priority populations.
Just as VBHC promotes grouping patients with similar needs, it also encourages measurement of health outcomes for each patient, utilising this information to drive ongoing improvements.14 Although the strategic documents proposed various high-level outcome measurements – such as process indicators, cost measures, and clinical outcomes – they did not list patient-centred outcomes. Kidanemariam et al. found similar results in their scoping review, which looked at measures used to assess the effect of VBHC implementation and to examine to what extent the evidence indicates that VBHC supports a patient-centred approach.35 They propose that organisations develop outcomes that matter to consumers. This approach aligns with what the Australian Commission on Safety and Quality in Health Care (the Commission) has advocated.36
Limitations
The study did not consider the strategic documents at the local district level that finance most of Australia’s publicly available hospital services. It also excluded documents produced by non-health sectors and other industry models that operate within similar consumer-focused frameworks and social and political contexts.
Recommendations
The review identifies three recommendations.
Public and private organisations developing digital health initiatives should use the 10 key processes to ensure alignment with VBHC principles.
Governments and peak bodies should rely on insights from priority populations to create inclusive pathways through co-design and address barriers to digital health innovations.
The Commission should establish clinical governance standards that link outcomes and actionable steps to maximise value from these initiatives, recognising PREMS and PROMS as key performance metrics within the ecosystem.
Conclusion
Implementing VBHC in digital health is complex. This review found that although strategic documents generally align with VBHC principles, there is still room for improvement. The study identified 10 key processes to guide the development of digital health innovations that adhere to VBHC principles. Additionally, the review highlighted opportunities for further enhancement, such as addressing the needs of priority populations through co-design and developing patient-centred metrics to improve the effectiveness and accessibility of services.
Data availability
The data that support this study are available in the article and accompanying references.
Acknowledgements
The authors wish to express their gratitude to Kate Kiehl for her outstanding graphic design contributions and to Nikki May for her helpful comments on the manuscript.
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