Accountability & Evidence: Setting a High Bar for DTx Solutions

Chronic disease makes up a major portion of the total healthcare spend in the U.S. and globally, driving the development of increasingly advanced, AI-supported digital therapeutic (DTx) solutions for chronic disease management. Consequently, digital therapeutics are rapidly becoming a new category of medical treatment poised to address difficult-to-treat conditions such as diabetes and musculoskeletal pain.

Data-driven and supported by evidence, digital therapeutics deliver software-generated therapeutic interventions directly to users to prevent, manage, or treat a medical condition or disease. While much work remains for digital therapies to be integrated into and across the U.S. healthcare ecosystem, DTx solutions are profoundly influencing how healthcare is delivered and consumed across the world.

DTx is here. What does this mean for health plans and their providers?

The advent of digital therapeutics has great potential to drive member loyalty, motivate adherence to a treatment regimen, and ultimately change existing behaviors. Data show that users can undergo shorter and highly individualized treatment programs using DTx to complement existing treatment. For payers, particularly insurers and employers who sponsor insurance plans or directly cover medical expenses, this can lead to lower costs as digital therapeutics help users get better faster and identify those at most at risk of developing a serious illness or chronic condition.

Operating in this competitive scenario, organizations are increasingly challenged to manage financial risk yet improve the care of enrolled members within a changing regulatory environment…all while building relationships between the employees and their employer or organization. Simply put, health plans and their providers must transform business models to integrate and deliver cost-competitive solutions that improve member outcomes and deliver sustainable growth for the organization.

Digital therapeutics represent one of the most impactful means by which to achieve these goals, offering health plans the opportunity to create value for members while gaining competitive advantage by adding business via greater access to care.

DTx companies must rise to the occasion

To help health plans and third-party administrators meet this challenge, the digital therapeutics industry must set the bar for performance and accountability. Adding high-quality DTx solutions for a health plan’s enrolled base can confer bottom-line benefits, including: 

• Risk mitigation through decreased dependency on medication (opioids)
• Cost reduction and reduced waste by providing digitized solutions as complements to or alternatives for high-cost surgery, injections or clinic-based therapy
• Preventing future spend by providing better support at the early stages of an illness or chronic condition

Setting the bar also means that DTx solution providers bring rigor to health economic outcomes analysis – to target members who could benefit most – resulting in fewer claims, fewer healthcare services used, and lower medical spend compared to traditional solutions.

Choosing the right DTx solution includes selecting a digitized program that is evidence-based and data-driven. Delivering evidence-based solutions means the maturing DTx industry must build its success on higher levels of evidence through well-designed, prospective clinical trials demonstrating improved outcomes, ideally along with reduced spend. Evidence for efficacy should come from independent institutions to ensure proper interpretation of the data generated by trials, and ideally, several properly controlled trials should support the evidence for each DTx solution. 

The ideal DTx solution should be able to improve quality and lower or stabilize total cost of care across broad patient populations, including Medicare and Medicaid enrollees, commercially insured individuals, and employee populations. It should also complement existing treatments in a meaningful way, increasing accessibility to underserved populations and making outcomes more sustainable after discharge from a traditional treatment plan.

Data-driven means performing detailed claims data review to demonstrate the ability of a DTx solution to complement traditional treatments, increase accessibility, and improve sustainability of outcomes while decreasing downstream, low-value care. This includes periodic review of DTx engagement for a better understanding of the member population and associated health condition costs, and to project and measure return on investment (ROI). DTx companies that strategically approach ROI and value on investment (VOI) propositions for digital therapies can support health leaders in delivering digital solutions that are more cost-effective than, and complementary to, traditional pathways or general digital health solutions.

To learn more about making DTx solutions work for your population, visit Kaia Health or book a demo. Our products tackle top cost drivers such as musculoskeletal (MSK) conditions and COPD with a blend of expert medical knowledge and evidence-based techniques that deliver measurable results, create value, and boost customer loyalty.