CTBH in the News! CTBH Director Lisa Marsch talks about digital therapeutics as keynote speaker at the OPEN MINDS Technology & Analytics Institute | The Center for Technology and Behavioral Health

Are You Ready For A Prescription For Treatment Tech? (OPEN MINDS– April 22, 2021 – Full Article)

By Monica E. Oss

The global digital therapeutics market size was estimated at $3.5 billion in 2020 and is expected to reach $4.4 billion in 2021. Analysts estimate a compound annual growth rate of 23.1% and predict that the market will reach $19.1 billion by 2028 (see Digital Therapeutics Market Size & Trends Report, 2021 – 2028). Investments by venture capital as well as pharmaceutical companies in this space are growing.

Why does this matter to specialty provider organizations caring for consumers with chronic and complex conditions? And why now? We got some great perspectives on the current possibilities with digital therapeutics from Lisa Marsch, Ph.D., Director of the Center for Technology and Behavioral Health at Dartmouth College, our keynote speaker at the OPEN MINDS Technology & Analytics Institute during the session, Digital Therapeutics For Behavioral Health: Anytime/Anywhere Health Care and the ensuing thought leader discussion. We talked with her about how digital therapeutics can improve treatment outcomes for consumers with mental illness and substance use disorders when used in conjunction with traditional service delivery and medications.

How is a digital therapeutic different from a wellness app? Dr. Marsch defined digital therapeutics as clinical grade software to prevent, treat, or manage a disease or disorder. She said, “It’s taking clinically validated medical treatments for various health conditions and delivering those treatments entirely through software. So it’s packaging an entire model of care into a seamless digital delivery platform.” Digital therapeutics could include cognitive behavioral therapy, problem solving therapy, techniques to promote medication adherence, and more. However, there is no synchronous communication with clinical professionals—all content and functionality is embedded in the interactive software platform that delivers the therapeutic tools.

Dr. Marsch said, “It’s kind of like a clinician in your pocket. Digital therapeutics tools can extend the reach and the impact of clinicians, be available to patients 24/7, and really reinforce what’s being offered to them in a clinical setting.” Prescription digital therapeutics require authorization by the Food and Drug Administration (FDA), and can only be prescribed by a clinical professional after clinical trials. And, the FDA recently sped approval of digital therapeutics—particularly in psychiatry (see Enforcement Policy For Digital Health Devices For Treating Psychiatric Disorders During the Coronavirus Disease 2019).

What’s out there? Digital therapeutics fall into four categories—those that address a medical condition, manage or prevent a medical disorder or disease, support medication, or treat a medical disease or disorder.

Digital therapeutics that address a medical condition include The Dexcom G6 system for glucose monitoring combined with BlueStar, which is FDA cleared for Type 2 diabetes self management (see Welldoc & Dexcom Expand Strategic Partnership To Integrate Platforms & Offer An Integrated Type 2 Diabetes Management Solution).

Among digital therapeutics that help manage disorders is the game-based prescription digital therapeutic, EndeavorRx, to improve attention function in children with attention deficit/hyperactivity disorder (see FDA Approves First Game-Based Prescription Digital Therapeutic For Children With ADHD).

Digital therapeutics that optimize medication include smart pills equipped with embedded sensors or cameras, such as Abilify MyCite, that track ingestion and alert care coordinators about missed dosages (see OIG Approves Otsuka Plan To Loan Smartphones To People Taking Its Digital Medicine Antipsychotic, Abilify MyCite).

A digital therapeutic that treats a medical disease or disorder is the FDA-cleared Freespira to reduce or eliminate symptoms of panic attacks, panic disorder, and post-traumatic stress disorder (PTSD) in 28 days (see Highmark Health Expands Access to Freespira’s Digital Therapeutic Treatment for Panic Attacks, Panic Disorder & PTSD). Germany recently approved Deprexis, a depression treatment therapeutic, for medical prescription and reimbursement (see Germany Approves Digital Mental Health Apps For Prescription). Otsuka Pharmaceutical and Click Therapeutics have launched a fully remote clinical trial to measure the effectiveness of a digital therapeutic intervention for major depressive disorder (see Otsuka & Click Therapeutics To Develop Digital Therapeutics For Major Depressive Disorder). CenteredVR, a virtual reality-enabled mindfulness and stress management program for clinical professionals has been shown to decrease stress levels by 34% on average, reduce anxiety, and enhance the overall mental health and well-being (see BehaVR’s CenteredVR Eases Emotional Toll Of COVID-19 On Health Care Workers).

Are digital therapeutics effective? Over many years of research, digital therapeutics used in behavioral health treatment have yielded outcomes that are comparable to or better than care delivered by clinical professionals. For example, an intensive behavior change digital tool for substance use disorders (based on the community reinforcement model used by clinical professionals) tested by Dr. Marsch and her team has been shown to roughly double drug abstinence rates when used as part of the therapeutic model, compared to standard addiction treatment. A study found that 86% of consumers treated with Freespira’s digital therapeutic for panic attacks were symptom-free immediately after treatment and 73% were still symptomfree 12 months post treatment. The majority of patients were free of panic attacks and/or reduced their symptoms and avoidance behaviors one year after Freespira treatment. Mean overall medical costs were reduced by 35% from $548 to $358 per member per month (PMPM). There was a 65% reduction in emergency department costs from $87 to $30 PMPM. Median pharmacy costs were reduced by 68% from $73 to $23 per member per month. (see Evaluating The Impact Of Freespira On Panic Disorder Patients’ Health Outcomes & Healthcare Costs Within The Allegheny Health Network).

Digital therapeutic tools allow personalization of care. Dr. Marsch explained, “They don’t always have to work the same way. We don’t have to have 12 sessions or eight sessions of treatment every time. Digital therapeutics can be responsive to the needs and preferences of the individual and the changing clinical trajectories of individuals over time.” These tools also expand access to care, helping to reach the majority of people who have a substance use disorder or mental health problem but don’t seek care in traditional models. “If a digital therapeutic is the only thing that someone would try in the privacy of their own home, it can be a stepping stone to seeking care with a clinician in a health care system,” Dr. Marsch said. However, it’s important to be mindful of the digital divide and look for workarounds when lack of bandwidth impedes access for consumers.

So how do clinical professionals prescribe from the plethora of digital therapeutics starting to enter the market? The key is what consumers will get coverage for. A digital therapeutic currently costs $900 to $1,200 out of pocket but the big challenge is that the Centers for Medicare and Medicaid is not yet reimbursing for digital therapeutics. However, more employers and health plans are starting to cover the cost—and CVS and ExpressScipts are developing digital therapeutic formularies. Children’s Community Health Plan in Wisconsin has made Freespira’s digital therapeutic for panic attacks and PTSD available to all consumers, including those covered by Medicaid (see Children’s Community Health Plan Is First In Wisconsin To Offer New Digital Therapeutic Treatment For Panic Attacks, Panic Disorder, & PTSD). Freespira is also covered by Highmark, the fourth-largest Blue Cross Blue Shield-affiliated health plan serving 5.6 million health plan members in Pennsylvania, Delaware, and West Virginia (see Highmark Health Expands Access To Freespira’s Digital Therapeutic Treatment For Panic Attacks, Panic Disorder & PTSD). And, in Indiana, the state is providing access to Pear Therapeutics’ FDA-authorized prescription digital therapeutics for the treatment of substance use and opioid use disorder to participating provider organizations in a variety of outpatient treatment settings and opioid treatment programs (see Pear Announces Indiana Family & Social Services Administration Division Of Mental Health & Addiction Will Provide Access To Prescription Digital Therapeutics For Substance Use & Opioid Medication Addiction).

And for provider organizations that are in (or are considering) value-based payment arrangements, tools that can improve outcomes for consumers and save costs system-wide can increase “preferred provider” status with payers. And for provider organizations in fee-for-service arrangements, prescribing digital therapeutics for consumers could free up the time of clinical professionals (with fewer face-to-face sessions) and help them see more consumers.

For more on enhancing your digital toolbox and improving treatment efficacy, check out these resources in The OPEN MINDS Circle Library:

And for even more, join us on May 13 for the Executive Web Forum, Making Value-Based Reimbursement Work – Best Practices In Program Design & Management. Ashley Gibson, Director Of Payer Relations, Contracts & Utilization, Hazelden Betty Ford Foundation and Donna Esposito, Director of Payer Relations, THRIVE DETECT, will share case studies on the development, design, and management of value-based reimbursement programs.

This reprint appears with the permission of OPEN MINDS. For more information, visit their website at www.openminds.com. To contact the author, email openminds@openminds.com.