Closed Health Systems As Early Adopters and Incubators for Digital Behavioral Health Therapeutics

OBJECTIVES: Despite promise in behavioral health (BH) and health outcomes, Digital therapeutic (DTx) coverage and adoption is limited in the United States (US). This study sought to examine the role and opportunity for evidence-generation partnerships to aid in future decision-making on adopting DTx.

METHODS: Secondary research assessing adoption-driving policies of key US healthcare stakeholders, including BH government stakeholders (n=7), provider organizations (n=3), industry groups (n=2), health networks (n=5), payers (n=5), and patient advocate organizations (n=2). Additionally, from 468 digital BH companies in the US (excluding wearables), twelve were selected for access and coverage analysis based on company size (Series C $30M+, total raised equaling $100M, or IPO). Expert interviews (n=2) were conducted to supplement and verify findings.

RESULTS: Closed health systems (e.g., Integrated delivery networks (IDN) that also provide benefits) lead in digital BH access, in part, due to partnerships with DTx companies for evidence development. Innovative private IDNs have taken a piloting approach to testing products within networks, allowing for evidence generation of clinical efficacy, use case, cost savings and effectiveness, and contracting information in specific populations. These partnerships serve to generate health economic, clinical, and real-world data which are used by stakeholders, including regulators. Despite innovative platform development and pilot trials, no products have received widespread coverage, and only one pilot publication reported clinical and financial benefits that may have been pivotal in coverage decisions.

CONCLUSIONS: Closed health systems and DTx companies have tested various frameworks for evidence generation. Payers, manufacturers, and policy decision-makers should commit to the adoption of such frameworks to ensure appropriate DTx adoption. Increased transparency from pilot programs and publication of clinical and financial outcomes may also positively impact the adoption of BH DTx.