Digital therapeutics are nascent in the digital health landscape. App companies, consumers, employers, and health systems are all in the mix for payment of the services the apps provide. Looking at the long tail for the health of the industry, defining clear value will be imperative in this coming decade. The gold standard for evidence is a randomized controlled trial. From inception to publication, it can take 3-7 years, how will digital therapeutics frame their value for health systems as customers given the extended time frame in traditional scientific inquiry.
A new paper by Adam Powell, President of Payor + Provider Syndicate, USA, and colleagues published in BJ Psych Open addresses different payment models for mental health apps as they relate to value. The authors lay out all the traditional pathways to reimbursement in the current fragmented health care environment in the USA. Current Procedural Terminology (CPT) codes are widely used for payment and indicate a level of service and care people receive in their doctor’s office. A challenge for digital therapeutics following this route is current state codes are linked to procedures that are bound to office visits. In contrast, the value of digital therapeutics is they can support care between visits. It would not be straightforward to parse out how they would fit in a narrowly defined set of procedures. The table below shows the source of reimbursement and current payment channels. These will need to evolve to allow space for digital therapeutics.
We are early in our understanding of how the apps for mental health can support care. Several new studies have shown they can reduce the burden of suffering for depression and anxiety. Challenges of deployment continue to exist, how will these tools are embedded into workflows optimally? How will they be added to Electronic Health Records (EHRs)- which are the the foundational elements that underpin care models. New models will emerge and will need to adapt to include digital therapeutics. Once this happens with more regularity and depth, the value will become more apparent.
Do current models of value allow for digital therapeutics to thrive as an industry. New CPT codes have been released for telemedicine showing some evolution in how CPT codes are developed. For now, going directly to consumers or payments directly from employers or health systems is the most viable path for financial stability. As new models of care will undoubtedly develop from this digital era- the ability to close gaps in care and have real-time data monitoring will lead us to ways to support health.
Thanks for reading – Trina
(Opinions are my own)
Generating Value with Mental Health Apps