Get Ready for Digital Therapeutics
Omada Health predicts it is ushering in a new era of medicine called “digital therapeutics.” Digital therapeutics is based on delivering behavioral medicine over an internet connection.
The real future of medicine for 75% of us is behavior change, not traditional medicine. We’re on a mission to inspire people to change the specific habits that put them at risk for serious, but preventable disease. And to do so in a way that is effective, engaging, and affordable as possible. – Sean Duffy, Omada Health
The success of behavioral medicine has traditionally been tied to an emotional connection formed through a face-to-face interaction. Omada Health delivers behavioral medicine through virtual health coaches and online support. Its first initiative is Prevent targeting diabetes, and is based on the CDC’s ten-year Diabetes Prevention Program. But delivered digitally, Prevent aims to scale to address the 85 million Americans who are prediabetic.
What If Doctors Could Prescribe Behavior Change?
Duffy says, “The world urgently needs better ways to bring behavior change therapies to the masses, and advancements in digital tech are finally enabling us to orchestrate the necessary ingredients to make that happen in a clinically meaningful way.” Prevent puts together the technologies, resources, community, and coaches to enable a reimbursable model for behavior change.
Participants start by being given a digital scale with a cellular chip (no cell phone or Wi-Fi connection are necessary), and are assigned to a group of people that are similar demographically (age, location, BMI.) There is a core phase of 16 weeks, graduating to a sustainability phase. Speaking at LeWeb ’14 in Paris last month, Duffy explained that health coaches are key, and that the program works. Data on its success has already been published, and another two-year study has been submitted for peer review.
Behavioral Medicine Works
Duffy says behavioral medicine works, “When you use digital to do that, and you can very accurately monitor your outcomes, and charge for those outcomes, it actually enables you to commercialize that clinical outcome in the same way as any other medical intervention. Through the host of human history, clinical outcomes have usually been created with a molecule, with a device, or a procedure. Technology can now get a clinical outcome.”
Companies who want to pioneer in this space must be ready to deliver exceptional online experiences, while establishing and exceeding the highest scientific standards.
Virtual Health Coaches on the “Rise”
According to Wired, since “Rise” was founded last year, the company “has connected thousands of users with hundreds of live, registered dietitians for $10 to $15 a week.” The dietitians provide clients with feedback on every meal, as well as encouragement along the way. Rise’s founder, Suneel Gupta, says a trained specialist is vital to making sense of it all.
Rise is one of the many apps that will be integrating with Apple’s HealthKit, and the first to allow users to send nutritionists information on their fitness habits. He calls it “microcoaching”. Users upload photos of their meals to share with their nutritionists.
Gupta says results are better than in-person coaching because they are constant.
The key differentiator in digital health is that monitoring in real-time provides continuous data, and creates a continuous feedback loop, as opposed to incremental snapshots delivered during periodic doctor visits.
HealthKit: Can You Bill for It?
Dr. Ricky Bloomfield is the Director of Mobile Health Technology at Duke University. In a recent blog post, he brings up some interesting information related to reimbursement, CPT codes, and remote monitoring. First, Dr. Bloomfield prefaces his comments with a disclaimer:
Disclaimer: I’m not a coding expert, and the application and reimbursement of these codes can vary by state, so please consult with your healthcare institution for details regarding how these might be used at your facility.
The big deal announced last month was code 99490, which is new as part of the CMS Final Rule for 2015, and will be available starting in January 2015. This is an E&M code that can be used for remote chronic care management with a monthly unadjusted non-facility fee of $42.60. Unlike the other E&M codes, this code does not require the patient to be present. Thus, for the first time, this code could potentially be combined with codes 99090 or 99091 for total monthly unadjusted non-facility fee of $99.52.
Just the Beginning for Digital Health
As evidenced by the exponential growth and investments in digital health, we are only at the beginning of what will be possible as more technologists partner with healthcare institutions, providers, patients, and other stakeholders. In the news:
- The Commonwealth Fund held a twitter chat as an outreach for digital health ideas.
- Walgreens announced its partnership with MDLive to deliver telemedicine, and is expanding its partnership with diagnostics pioneer Theranos.
- Salesforce, Philips and Radboud University have formed a partnership to transform healthcare.
- Mayo Clinic, a partner in HealthKit, teamed up with TechStars accelerator, and
- Venture firm Kleiner Perkins provides advice to startups about digital health security and HIPAA (interview with Practice Fusion and Mango Health.)
It is an exciting time for healthcare innovation!
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