About digital therapeutics
Digital therapeutics, also called DTx, is a digital capability that exists within the broader category of digital medicine. DTx solutions are evidence-based, clinically validated and scalable software applications used to treat, manage, and/or prevent a variety of diseases and disorders in order to improve health outcomes and reduce costs. In addition, solutions are provider-prescribed, include privacy and security protections, and have received approval from the appropriate regulatory bodies.
How digital therapeutics differ from other digital health solutions
Unlike general wellness apps, which are available to anyone and do not require review or approval from regulatory bodies, digital therapeutics are specifically created to be prescribed or recommended by healthcare professionals, and are subject to the same regulatory requirements as traditional medical treatments. When selecting digital therapeutics, health systems should take care to look for clinical evidence. These solutions will often be labeled as clinically validated, with readily available research studies to support this designation.
Many digital therapeutic solutions address specific health conditions–in particular, major chronic diseases and behavioral health conditions. Compared to remote monitoring solutions, which require continuous attention from care teams, digital therapeutics are designed for greater user independence from care team oversight and direct intervention.
Reimbursement opportunities for digital therapeutics
Currently, the most common reimbursement pathways for digital therapeutics are through contracts between manufacturers and payers for service-based billing codes, i.e. the amount of time providers spend reviewing data. Certain remote monitoring and remote therapeutic monitoring CPT codes may be applicable, along with cognitive behavioral therapy-related codes in some cases.
How digital therapeutics are used to deliver care plan content
After receiving prescriptions from their providers, patients interact with digital therapeutics and receive content and interventions in a variety of ways, including:
- Customizable assessments to establish baseline clinical data and behaviors
- Evidence-based intervention pathways assigned by providers
- Personalized patient engagement that may include education, task lists, goal-setting and progress monitoring
- Virtual coaching to educate patients on how behaviors affect outcomes
The case for digital therapeutics
Digital therapeutics offer a multi-pronged value proposition to support revenue and address key health system challenges. When used to their maximum benefit, DTx solutions may provide some of the following advantages:
- Expanded clinical workforce capacity. AI-driven digital therapeutic solutions require limited care team intervention, but still provide effective personalized recommendations to meet individual patient needs. This capability is likely to prove especially important as patient populations continue to age and expand,
- Improved patient engagement and satisfaction. Patients receive tailored recommendations for their unique health conditions through frequent interaction with engaging interfaces. These frequent touchpoints can serve to motivate behavior change and care plan adherence, influence better care outcomes, and may ultimately drive patient satisfaction.
- Reduced costs. As healthcare continues its shift toward value-based care, digital therapeutics can help health systems navigate this change by facilitating better health outcomes and potentially reducing preventable utilization.
- Support for revenue-driving specialty service lines. Digital therapeutics provide more patients with convenient, accessible, and engaging ways to receive care, while freeing up providers to focus on more complex cases.
- Tools to advance health equity. Digital therapeutics can cross geographic, linguistic, and cultural barriers to deliver personalized interventions to patients in their own languages and familiar environments. DTx solutions are also not constrained solely to uninterrupted broadband access, and can deliver interventions and collect data with only intermittent access.
Other potential long-term benefits may surface as technology and the regulatory landscape continue to evolve. Strategic investment in digital therapeutics could provide competitive advantages for health systems compared to organizations with less advanced or no digital tools.
CMS has indicated that Congress must act to create specific reimbursement guidelines for digital therapeutics. As of March 2023, legislation has been proposed in two successive legislative sessions, and lobbying efforts have expanded through industry groups such as the Digital Therapeutics Alliance.
Use cases for digital therapeutics
Digital therapeutics support a wide range of use cases across different populations and clinical activities, such as behavioral health, chronic condition management, and other specialty use cases.
In behavioral health, DTx can be used to treat a number of conditions, such as anxiety, depression, PTSD and substance use disorder. Beyond therapy and medication, DTx solutions offer a scalable third option for consumers, who can access clinically proven care plan content on their mobile or desktop devices and rely on it as a viable pathway to care. Current behavioral health solutions offer cognitive behavioral therapy, gamified ADHD and depression interventions, cognitive emotional tasks for depression, and functions to support parents with pediatric sleep, ADHD, and anxiety. In the substance use disorder space, DTx solutions can support abstinence and promote retention in treatment programs.
Among chronic disease patients, whose conditions generally require frequent interventions over a lifetime, DTx can provide daily coaching to support crucial behavior change and care plan adherence, including medication and exercise reminders and tips to manage symptoms. Providers can also prescribe DTx solutions to monitor vital signs, analyze data, and more readily identify signs of deterioration.
What leading digital therapeutics companies/solutions offer:
- Multimodal delivery options that allow patients to choose how to engage. Options include desktop, mobile apps, text messaging, and other connected devices.
- Personalized care plans that deliver customizable treatment. Leading solutions offer libraries of evidence-based medical and psychosocial intervention pathways. Content is delivered in accessible, personable language to meet patients where they are.
- Connected FDA-approved devices as needed to monitor specific conditions. Devices should support automatic and/or patient-triggered data upload.
- Real-time data collection and response with AI-driven coaching. In addition, health systems must work with solution companies to determine where this data flows and the associated care pathways.
- Integration and interoperability with EHR and other relevant software. Leading solutions are accessible to providers in their native workflow and easily exchange data with other solutions, such as prescribing software.
Organizing for success with digital therapeutics
Start with the problem or vision to determine where a digital therapeutic may support the clinical workflow
Before deploying a digital therapeutic, health system leaders should develop a vision or articulate a problem that a solution could address in order to improve patient care. Start by identifying the types of conditions that can be treated with a digital therapeutic. Systems should also establish key performance indicators to optimize the deployment process.
Seek provider buy-in
As with virtually any new digital health solution, effective usage and scale depends on end user buy-in. It is important to ensure that DTx solutions are user friendly and can be seamlessly integrated into the clinical workflow. As such, engaging providers early on in the selection process, adoption can be accelerated.
Provide effective training
DTx solutions must fit with existing provider workflows and health systems should provide ample training to ensure that providers understand the benefits of DTx solutions and how to use them effectively in patient care. Due to the evolving nature of digital therapeutics, this training should be ongoing to keep users up-to-date on solution capabilities.
Determine a strategy: build, buy, or partner
Health systems may also want to assess whether it makes sense to adopt third-party solutions, configure existing tools, or build a software solution from scratch. Some organizations may find opportunities for private sector partnerships that allow them to develop solutions that can scale beyond a single health system and diversify revenue streams beyond clinical revenue.
Identify technology infrastructure needs and constraints
Prior to adopting any digital therapeutics solution, health systems should assess their organizational readiness, determine whether existing tech infrastructure is robust enough to implement the solution, and make any required updates.
Engage in a thoughtful tech selection process
Third party validation, including reviews from other health systems, are crucial to help organizations identify the solutions with the greatest potential for success. In addition, health systems should explore solutions from their existing EHR vendors–many EHR companies offer native tools that can easily fit with existing workflows and architecture.