As apps play an expanding role in mental healthcare, their complexity is, in some cases, simultaneously increasing, explains Adam C. Powell, PhD. “Understanding the value delivered by apps, and how to quantify it, is an important predicate to getting apps widely adopted,” he adds. “Apps vary greatly in both cost and effectiveness. Nonetheless, it is often difficult to determine the effectiveness of apps with the current data that are publicly available, as the data are often generated by the app developers themselves. Credible data about effectiveness, paired with cost data, can be used by payers to determine which apps they wish to make available to the patient populations they serve.”

For a paper published in BJPsych Open, Dr. Powell and colleagues explored how apps are currently generating value and being reimbursed around the world, with a particular focus on the United States. An international team performed secondary research on the use of apps and on common pathways to remuneration.

“We found that apps are being used to support the diagnosis, treatment, and management of mental illness in multiple ways, in the context of preventive, acute, and even emergency care,” Dr. Powell and colleagues wrote. “There are more than 250,000 health apps available, according to industry reports. The US iOS App Store contains more than 300 apps to address anxiety disorder alone. Nonetheless, we learned that there is no single means through which costs associated with mental health apps are being reimbursed.”


Mental Health in Top Three Health App Categories

The study team noted a national survey that reported mental health apps were in the top three categories of health apps downloaded. “Apps have the potential to increase access to care for people who might not otherwise seek professional care, as patients may use apps independently or be encouraged by apps to seek in-person help via app-based screening and diagnosis,” they wrote. “For example, a 2014 study offered depression screening to more than 8,000 people across 66 countries and encouraged those with elevated nine-item Patient Health Questionnaire scores to seek help. Since then, a multitude of screening apps have emerged.”

Apps can also benefit those already in care, the researchers noted. “For example, people who have sought professional care are using apps both to interact with their healthcare provider via an additional channel, and to assess and treat their conditions on a standalone basis. Healthcare providers are also using apps to support administrative aspects regarding the delivery of care, such as care management and case management. Thus, mental health apps exist along a spectrum—some are used as a complete substitute for in-person care, and others are used behind the scenes to support in-person processes.”

Although many apps today are not regulated in the US, either because they claim to be wellness tools (rather than medical devices) or are in categories subject to regulatory discretion, several app developers are pursuing formal FDA approval, they added.


An App-Specific Channel for Reimbursement

“Our study suggests that there may be a need to develop a new channel for the reimbursement of apps, analogous to the channels used for drugs, devices, and laboratory tests,” says Dr. Powell. “There may be a need for additional policy work, with the aim of simplifying the app reimbursement process and better facilitating the reimbursement of apps that do no involve healthcare provider time.”

Although patients can use apps while at home, many apps today have little or no integration into the traditional care process, and as a result, may further the fragmentation of care, the researchers noted. “In the future, the frequency with which such apps are integrated into traditional care will likely increase,” they wrote. “By all metrics, the role of these healthcare apps will dramatically increase as apps are created to fill a broader array of needs, become more tightly integrated into the clinical workflow, and more evidence regarding the effectiveness of apps becomes available.”