Q&A: Why adopting digital therapeutics requires a healthcare paradigm shift


Digital therapeutic company Happify Health has announced several partnerships this year, including a collaboration with insurer Elevance Health, formerly Anthem, on maternal health and an agreement with pharma company Biogen aimed at multiple sclerosis patients.

Chris Wasden, Happify’s chief strategy officer, says these partnerships add access points for patients who could use their products. He sat down with MobiHealthNews to discuss the company’s partnership strategy, the business environment for digital therapeutics and how to encourage physician uptake.

MobiHealthNews: Happify has announced several partnerships recently, including the one with Biogen and another with Anthem. Why do these partnerships make sense for your company? 

Chris Wasden: For us, we’re focused on the individual patient. That patient goes by various different types of titles. Some call them members, if you’re a health plan. Some called patients, if you’re a physician or a pharma company. Some call them employees if you’re an employer. But they’re all the same person. They have a constellation of challenges when it comes to healthcare-related issues. 

What we find is that our experience in helping patients address their mental and physical health issues means that we need to have multiple channels to get at that patient, to provide them with our services and offerings. That’s why you see us with pharma relationships, health plan relationships, employer relationships. I think increasingly you’ll also see us with healthcare-provider relationships. Because they’re all partners that can help us provide our services to patients.

MHN: How do you choose partners? Does it depend on the condition or the health concern that you’re focused on?

Wasden: You have to first look at it from our perspective of how we stitch our products and services together, what we call a sequence. So a sequence is a bespoke collection of products and services – some are ours, some are third parties’ – that we’ve put together around a specific medical condition. 

The sequence for us starts with our patient community application. We call that Kopa. We have Kopa for pregnancy. We have it for MS. We have it for psoriasis. In that community, we have patients helping patients, but we also then insert clinicians as well. So clinicians can help patients within that community context.

Then we can triage people to understand how long they’ve had the disease, what sort of therapies they’re on, what’s working, what’s not working. We can guide them in their patient journey towards other digital products and services. Those would include such things as our wellness mental health solution, or it can include an MS-specific product that we’ve developed that helps patients deal with stress and anxiety, depression, and fatigue.

So that’s what we do. We look and see where we can move the needle on mental health in a related medical condition, and then set up a sequence. And we will have partners in these sequences. Now we don’t do exclusive deals with the pharma companies or with the health plans.

So these things that we announced with Anthem or with Biogen are things we can do with other companies in the same space as well. A lot of this is driven by our patient-centric approach. So if you’re a patient with MS, for example, you may be on Biogen’s drug one day, you may be on Novartis’ drug a year from now. Then you might be on Sanofi’s drug three years from now.

So you may have to change your medication throughout your patient journey. We need to be able to have partners that represent all your choices, so that we can better educate you about your therapeutic options.

MHN: Looking at the more general digital therapeutic space, what do you think the environment is like right now? Digital health funding has dipped so far this year. Do you think interest in these new modalities have kind of waned?

Wasden: We have a fundamental point of view that a disruptive technology – and I would classify digital therapeutics and what we’re doing in this space as disruptive – cannot succeed on the same basis and with the same paradigm as existing technologies. Because if it did, it wouldn’t be disruptive by definition.

I think what you see going on right now in this space is a search for the right business model. I do not believe that we’re just going to copy the pharma business model and say, “Okay, digital therapeutics are just like a drug, therefore they’ll be paid the same, they’ll be dispensed the same, they’ll be used the same.”

We actually are very different. Our modalities are different. Our mechanism of action is different. The frequency with which they’re used is different. The data that we collect is vastly superior to what any drug can collect – and the fact that we can complement so many things.

We can complement the practice of medicine. We can complement the use of a drug. We can complement the way you change your behavior and lifestyle around diet, exercise, sleep, things like that. 

So I think you’re going to see this evolving model now; we call this strategy precision care. You’re going to see this merger of precision medicine  which includes digital therapeutics  with step care, which is stepping up from a digital solution to a digital AI solution to a coaching/therapist/physician service. 

We personally believe that precision care will become the dominant model for prescription digital therapeutics and related services in the future. If you look at the merger between Headspace and Ginger, that’s a precision-care strategy merger. You look at the merger between Teladoc and Livongo. That’s a precision-care strategy merger. You look at the merger between Amwell and SilverCloud. That’s a precision-care strategy merger.

If you have this new model, how are you going to charge for it? Because there’s lots of different pieces, right? There’s coaching, there’s therapists, there’s physicians, there’s digital therapeutics, there’s a digital front door and a consumer-oriented part. You can have multiple different types of partners, from providers, to payers, to employers, to pharma companies. And so I think you’re going to find a lot of creative monetizing strategies that companies have as they pursue precision care as well.

MHN: How do you get providers on board? How do you get them interested in prescribing prescription digital therapeutics, or recommending them if they’re not a prescription product?

Wasden: I interviewed physicians in the diabetes space that were prescribing digital therapeutics a few years ago, and I said to them, “How do you decide when to prescribe a digital therapeutic to a patient?”

And they said, “We have five questions we ask.”

These are the questions: Number one, does this patient do what I asked him to do generally? They said about 20% of my patients never do anything I asked them to do. So I’m not going to ask them to do this either.

Then they say there’s about 20% of my patients that do everything I asked them to do. So do they really need the digital therapeutic? If they’re doing everything else I asked them to do, maybe not.

And then they say there’s 20% of my patients that don’t have a smartphone, or don’t have the data plan that they need, or don’t have the technological sophistication to do this. I’m not going to prescribe it to somebody who doesn’t seem to be tech savvy enough to use it. Then 20% of my patients just don’t have a health plan that would cover something like that.

After they go through that, what results is the 20% of their patients that are good candidates based on their judgment. I’m not saying that these physicians are right in their assessment and triage. But it almost doesn’t matter if they’re right, if that’s the way they see the world, and that’s how they’re going to behave. 

So that’s why when we look at these therapeutic areas, we need to think and ask ourselves, “Is this a product that would be prescribed to every patient with diabetes? Or would it only be prescribed to 20% of patients with diabetes, because of this screen, this triage that clinicians go through?”

I think we have to educate clinicians about what’s available, we have to educate them about which patients would use them and how. 

There’s also this concern that clinicians have, which was really brought to the fore when EMRs were being adopted 15 or so years ago, which is that doctors don’t want more data. They have alert fatigue. They’ve got data fatigue. So if this digital therapeutic creates more data, great, but I don’t want to be burdened by it unless it’s an emergency.

So who’s going to determine which data is showing an emergency versus superfluous data that I can ignore? What’s the risk of getting the data and ignoring it?

Now, I’ve brought disruptive technologies to market in the past. One of the things that I learned is that you shouldn’t spend any time in the early parts of the innovation lifecycle trying to convince people against their will to adopt technology.

You’ve got these early adopters of a technology, and the challenge of a company like ours and others in this space is finding those early adopters. Because those are the people you spend your time with. If you convince them, they will adopt.

Now, it’s only 20% of the market. But that’s okay. That’s how all new disruptive technologies are adopted. They’re adopted by these groups that are willing to experiment, try new things out. They get comfortable with it, and they start to use it. Then you’ve got that next group and then the next. Over the course of a decade, you then get mass adoption.


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