Stakeholders Address How Digital Therapeutics Can Bridge Unmet Needs in Behavioral Health Care

The rising mental health crisis in the United States has seen a substantial increase in demand and spending for behavioral care services, with an estimated 1 in 4 Americans prescribed medications to help them cope with stress, anxiety, or depression.

Despite market innovations, stakeholders of a session at AHIP 2022 discussed how the fragmented mental health care system continues to perpetuate barriers to care (cost, accessibility, stigma, etc) and prevent patients nationwide from getting the care they need. The role of digital therapeutics was further addressed as a cost-effective alternative to standard-of-care options of psychotherapy and prescription drugs, the latter of which poses significant adverse effects and overdose risks.

“Payers and health systems attempting to solve the [access] gap, build more networks, and yet the supply challenge still exists. We also know that payers and health systems are taking risks, they go out of network, and that cost becomes incredibly high. The challenges for the patient—that's great, I have access to a therapist, but there's a 3 month waitlist. Or worse, I have social determinants of health, so how would I get there?” said Gabriela Perez, chief commercial officer, Big Health.

As the former managing partner of Kaiser Permanente Ventures, Liz Rockett, MBA, MPH, venture partner, Unseen Capital, noted that coverage strategies to address mental health have shifted dramatically in the United States over the past couple of decades, but a substantial bottleneck remains in the demand and supply of mental health providers.

“Anyone inside of health plans or systems knows that a lot of our providers' time in behavioral health has been identifying what drug to put focus on, and then titrating that drug. And there's a large swath of our patient population that would prefer not to be on medication or may have been on medication for so long that it is actually not safe for them to remain on medication,” said Rockett. “We need to think more creatively about what kind of approaches people can get access to.”

Described as a safe and effective nondrug alternative for most common mental health conditions, Perez said digital therapeutics are a new clinical grade category that has yielded superior outcomes compared with any other mental health treatment on the market today. Her organization, Big Health, has designed 2 digital therapeutics for insomnia and anxiety called Sleepio and Daylight, respectively.

“How it works [is] we retrain your brain through personalized programs that adapt and deploy precision formulary treatment to the unique individual, and this interactive treatment allows you to achieve remission and is delivered through an app at scale,” explained Perez.

Listed in 4 clinical guidelines in the United States, including that of the American Psychological Association, as a first-line behavioral health treatment, Big Health’s care approach addresses the 4 P’s: personalized, participatory, predictive, and preventive.

“We are attached to the formulary,” Perez explained. “We are a claim, available for individual uses, and we put all of our fees at risk.” 

Rockett noted that her initial fear as an early investor in the digital therapeutics space was whether efficacy and outcomes would be prioritized in the marketing and distribution of care services, particularly in the mental health industry, which remains at a crossroads on requiring evidence-based metrics.

“As purchasers, we should be demanding that because it will make the whole industry step up to that level that we want to see and provide for our members and our patients. Thinking about accessibility, thinking about just sort of what is going to attract folks, and what's going to engage our patients or members. But then also, does it fit into your operations?”

Specific to mental health care advocacy and outreach, Rockett said more attention is placed on the integration of care services into provider contracting and drug channels. The availability of these metrics reduces the task for health plans and employers in determining who needs these interventions and where should it go, and instead allows for natural interest from populations of the providers seeking to prescribe these services, she added.

“In setting our standards of what we are out there looking for to help us act on the mental health access challenge, these are some of the things that we really can demand right now, and again, make the whole industry sort of step up to that challenge,” she said

As an industry leader in research and randomized controlled trials, Big Health’s research on Sleepio led to its recommendation by the National Institute for Health and Care Excellence as an alternative to sleeping pills for patients with insomnia. Additional investigations are underway to determine the efficacy of Sleepio and Daylight in patients with comorbidities such as cancer and stroke.

“We know that a mother and child who are not treated with perinatal depression are $30,000 more expensive than those moms that are receiving anxiety support. Follow the money, follow the claims to see the long-term savings and impact at the claims. What matters? We are in the risk business of managing dollars—we should not be in the business of sick care, but wellness prevention, and doing what's right,” said Perez.