About digital behavioral health
AVIA Marketplace defines digital behavioral health as the ability to leverage digital tools and scale behavioral health services, inclusive of mental health, substance use, and developmental disorders, for individuals of all ages. These digital capabilities span the care continuum, from prevention to identification and diagnosis to ongoing condition management, and serve both adult and pediatric populations.
How digital behavioral health differs from other service lines
While digital health solutions have been available for some time, the rise in sustained usage of digital behavioral solutions since the start of the COVID-19 pandemic has led to the emergence of behavioral health as one of the first truly digital-first service lines. Unlike medical or surgical specialties built around procedures, many behavioral health conditions involve assessment through interview and treatment with medication and psychotherapy. Most of these interventions can be conducted or prescribed remotely, and allow for quicker response times, greater convenience, and better access to care compared to traditional office-based practices.
“When patients are unable to access preventative or low-acuity care, their conditions often become more complex and severe. They may ultimately receive behavioral health care in high-acuity, high-cost sites of care like emergency rooms, which often lack the appropriate level of resources and infrastructure needed to provide effective interventions for these lower acuity patients.”
Reimbursement opportunities for digital behavioral health
Some services, such as virtual visits with therapists and psychiatrists or remote monitoring for physiological symptoms of behavioral health conditions, are eligible for reimbursement, though reimbursement rates for behavioral health services remain low and many providers choose to remain out-of-network with all providers.
Some payers may also choose to reimburse for digital therapeutics or offer those interventions directly to members, but Congress must authorize the creation of 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.
How digital behavioral health solutions deliver care
Many types of digital behavioral health solutions are available or entering the market, and while individual approaches vary, they exist within three primary categories:
- Direct-to-consumer. These solutions focus on providing services to individuals with lower acuity needs, such as coaching, chat/talk therapy, self-guided tools, meditation, and sleep.
- Payer-focused. Solutions in this category often target the lucrative employer market, with functionalities designed to address employee burnout and improve healthcare spending. These products have also found traction among university customers in order to address unmet behavioral health needs among student populations.
- Health system-focused. These solutions typically serve one of three purposes: to extend the clinical workforce, expand access to care, or support behavioral health integration.
The case for digital behavioral health capabilities
Health systems that leverage digital are better positioned to drive clinical innovation, with high-impact opportunities that include:
- The ability to electronically administer evidence-based assessments at most or all entry points into the system, such as primary care or emergency departments (EDs).
- Behavioral health care integration at scale, with common services embedded into standard workflows across all care settings.
- ED-based mental health interventions to facilitate effective early intervention for treatment initiation and referrals.
- ED-based substance use disorder interventions, including screenings, support for SBIRT programs, and referrals for follow-up care.
Digital behavioral health capabilities can also help expand access to care and build provider capacity, which are crucial benefits amidst nationwide provider shortages and high demand for services. Key opportunities with proven solutions include:
- On-demand behavioral health support across the acuity spectrum, delivered either synchronously or asynchronously. Cognitive behavioral therapy (CBT) programs are a common starting point for most organizations.
- The ability to connect patients with peer support services to supplement their recovery from substance use disorder.
- Teletherapy and telepsychiatry services, delivered in the patient’s preferred language and with the option for medication home delivery via mail order pharmacy.
- Virtual medication-assisted treatment for patients with substance use disorder, with multiple language options and medication fulfillment via mail order pharmacy.
Use cases for digital behavioral health
As organizations continue to seek ways to extend behavioral healthcare to more care settings and intervene before patients resort to costly ED visits, more companies and products arrive on the market to solve for a growing number of use cases.
Behavioral health integration
Primary care sites can expand behavioral health services with embedded screening assessments and clinical decision support tools, on-demand teletherapy or telepsychiatry consults, and closed-loop referral solutions.
Pediatric and adolescent care
Children and adolescents face even greater behavioral healthcare shortages than adults, but organizations can work to close care gaps with virtual visits to connect patients with psychiatric care and talk therapy, digital therapeutics for conditions like anxiety or ADHD, and gamified or incentive-based care plan adherence tools.
Employee health
Employers and payers can leverage digital to deliver evidence-based and personalized support at scale with self-guided mindfulness and resilience training, telehealth EAP services, prevention chatbots, and curated content libraries.
Substance use disorders
Digital solutions place recovery tools within reach for more patients with virtual medication-assisted treatment for opioid use disorder, prescription digital therapeutics to promote abstinence from alcohol and other substances; and digital screening, triage, and referral solutions to help providers at all points of entry identify at-risk patients and refer them for appropriate resources.
ED-based interventions
When patients in crisis present at emergency departments for help, health systems can utilize digital tools to deliver evidence-based support and follow-up communication for patients at risk of suicide, immediately initiate treatment for opioid use disorder, or automatically locate the appropriate inpatient setting for patients who require higher levels of care.
What leading digital behavioral health companies/solutions offer:
- Outcomes that demonstrate clinical value for patients, families/caregivers, and relevant partners
- Analytics to identify patients who at risk of their conditioning worsening or potential hospitalization, with the ability to notify the appropriate family members and care teams
- Established billing and reimbursement processes and systems
- Effective parent and youth consent management
- Demonstrated traction in the applicable markets, such as Medicaid or ACOs
- History of successful implementation with customers in target markets, such as health systems or Medicaid programs
- Support for frictionless implementation, including logistics management and staff training, support for end users, and ongoing tech support
Organizing for success with digital behavioral health
Health systems and other organizations can maximize the likelihood of successful implementation and effective usage when they ensure that the right foundation is in place. Priority items for health systems include:
Understanding which existing tools can expand use cases to serve behavioral health needs.
Existing tools, such as enterprise-wide patient engagement solutions, may be upgraded or adapted to extend behavioral health services, conduct virtual telepsychiatry and teletherapy sessions, and make the appropriate referrals.
Identifying where new tools and solutions are needed
Organizations should extrapolate where new digital capabilities are truly needed, and determine the optimal starting point to fit with their needs and available resources.
Developing or sustaining referral networks for services that exceed scope
Health systems should build or retain robust referral capabilities in order to seamlessly connect patients with the right services.
Consider the needs of emergency department providers before investing in any solution
Emergency department providers typically see the highest volume of patients with unmet behavioral health needs, and require the right tools to identify, triage, and refer patients to the appropriate level of care.
Leverage third-party feedback while vetting potential solutions
Third party validation, including reviews from similarly-sized health systems, are crucial as organizations consider the clinical value, business case, technical demands and user experience of any new solution.
