The use of digital therapeutics in behavioral health offers many benefits, but their adoption and incorporation are associated with challenges, according to Patricia Areán, PhD, and John Fortney, PhD. The first step is selecting specific tools and apps for use in practice. “There are quite a few companies that review these tools for their evidence base, user satisfaction, and the features they employ,” notes Dr. Areán. “There are at least 100,000 apps available, but not all apps are the same in terms of what they offer—and not all are of good quality. As a result, it is nice that there are non-profit organizations that summarize them. One Mind’s PsyberGuide is a great resource.”
Integrating these strategies can often depend on patient preferences, she continues. “Apps are easily accessible, but in our experience, not everyone wants to rely solely on an app to help them overcome their problems. One approach is to use apps that provide tracking of symptoms, as well as side effects, and have the patient show how they are doing from day to day,” she adds. “Another way to use these apps is to support prescribed out-of-session work, provide reminders to practice skills, or perform behavioral exercises.”
Barriers to Access
Both Drs. Areán and Fortney highlight challenges associated with the use of digital therapeutics in behavioral health. Among other concerns, there are no billing codes for these services, according to Dr. Areán, and many apps require subscriptions that people cannot afford and that health insurance won’t cover. In addition, almost all mHealth apps do not integrate with EHRs, according to Dr. Fortney. “This means that the information collected by the app is not visible to clinicians,” he says. “Consequently, the ‘treatment’ provided by the app and the treatment delivered by the clinician are not integrated.”
Dr. Fortney also emphasizes the impact of e-health literacy as a significant barrier. However, he notes that clinics with care managers or health coaches can utilize these professionals to help patients with low e-health literacy navigate the technology.
Current & Emerging Strategies
One “silver lining” of the COVID-19 pandemic has been the widespread use of telehealth, according to Dr. Fortney. While rural Americans were much less likely to benefit than urban Americans, Dr. Fortney notes that the infrastructure bill signed by President Biden includes $65 billion for broadband, “which should address the rural-urban divide.” Dr. Areán says more policies like this “would help a lot” in tackling that divide.
Another strategy for improving access is the expansion of a program instituted under President Obama that provided eligible recipients with $9.25 per month to buy phone service, according to Dr. Areán. The expansion enabled participants to buy broadband with their subsidy. Eligible recipients—defined as those living at or below 135% of the poverty line—are given the same card, with $9.25 per month for discounted phone service but were also newly enabled to choose how to spend the money: on cell phone service or broadband.
“If you are eligible for federally qualified healthcare, you can get one of these phones,” Dr. Areán says, though she does not think knowledge of the program is widespread. She is also uncertain about the program’s limitations but believes such a program would help improve access to digital therapeutics.
“Finally, there is currently no way to bill for these services, so the creation of billing codes through CMS would be needed,” Dr. Areán says. “However, that is not the full answer. Individual access to devices is critical.”