Much like consumers are taking to technology to do their banking, their shopping, and their vacation planning – they are taking to using technology to direct their own health care, in a big way. FitBit is just one example – 4.8 million units sold in the last year quarter for $620 million in sales (see Fitbit & Apple Watch Triggered An 118% Surge In Sales and Fitbit Is A Victim Of Its Own Success). There are now over 13,600 health care apps, about six percent of which are focused just on mental health (see 36 Mobile Health Apps Account For Nearly Half Of All Downloads and Smartphones For Smarter Delivery Of Mental Health Programs: A Systematic Review). These mental health applications are a frequently topic in the popular press. There are recent stories in Fast Company (see How To Turn Your Smartphone Into Your Personal Therapist), The New York Times (see Depressed? Try Therapy Without The Therapist and Is Depression Treatable With A Mobile Phone App?), and U.S. News & World Report (see When Your Therapist Is a Computer).
Increasingly, consumers aren’t willing to wait for a scientific seal of approval to use new treatments and tools. Armed with information from the internet and online consumer support groups, consumers are focused on getting access to treatments and tools without waiting for the health care system to approve or pay for them. This isn’t limited to mental health tech treatment tools. Medications are another example – F.D.A. Regulator, Widowed By Cancer, Helps Speed Drug Approval and Right To Try Act Would Allow Greater Access To Experimental Treatments. Responding to consumer and political pressure, the FDA is responding with new fast tracking of medication approvals (see Overview Of FDA Expedited Programs With A Focus On Breakthrough Therapy).
But do tech-enabled, consumer-directed health care services work? And if so, how do they work best? This is an area where practice has outpaced science. I don’t think this is a bad situation – it just is. And it is a situation that health care organizations, payers, and policymakers need to acknowledge and address – that the development of the technology is happening faster than the traditional rigorous research to evaluate it. With regard to the use of tech tools for mental health and addictions, there is a concern that many of the tools are formally untested (see More Than 3,000 Mental Health Apps Available For Download, Limited Number With Evidence Of Efficacy). But there is growing evidence, from small-scale studies, that the tools can be effective (see Telemental Health: A Status Update, ‘Robust’ Evidence Supports CBT For Resistant Depression; Users Of FitBack Mobile App Less Likely To Report Ongoing Back Pain; Online Therapy Has Similar Benefits As Face-To-Face CBT; and Cognitive Behavior Therapy Via The Internet: A Systematic Review Of Applications, Clinical Efficacy & Cost–Effectiveness).
These preliminary results have led to initial adoption by consumers and payers. Recently, Minnesota’s largest health plan, Blue Cross Blue Shield of Minnesota, contributed a significant share of the $1 million in funding raised by the Minnesota online Cognitive Behavioral Therapy company (see Online Cognitive Behavioral Therapy (CBT) Company Learn to Live Raises $1 Million Round of Funding Led by Blue Cross and Blue Shield of Minnesota); and we’ve covered other insurers adopting these technologies over the years (see Companion Benefit Alternatives Offering Online Therapy for Depression and Anxiety and MHNet Behavioral Health Engages myStrength To Expand EAP Offering and Magellan Health To Offer Expanded Computerized Cognitive Behavioral Therapy Services).
What some of the emerging research shows it is not that the tech tools aren’t effective, but problems with use of the tools in “real life” settings are decreasing their impact – see Computerized Behavioral Therapy Could Boost Access To Care, But Barriers Remain and Computerised Cognitive Behaviour Therapy (cCBT) As Treatment For Depression In Primary Care (REEACT Trial): Large Scale Pragmatic Randomised Controlled Trial. In his presentation at The 2016 OPEN MINDS Technology & Informatics Institute, David C. Mohr, Ph.D., Director of the Center for Behavioral Intervention Technologies, discussed the challenges in getting maximum return from these technologies – a challenge that includes both finding the right tool for each consumer and integrating the use of the tool into the care process (see How Do You Pick The Right Health Care App?).
To keep up with the rapid deployment of “new science,” health care policymakers and researchers need to focus on how best to leverage these technologies in real world settings. For that, we need a focus on the implementation science and the service research (see Implementation Science: What Do We Know & Where Do We Go From Here? and Implementation Science In Health: Studying Organizational Processes & Programs To Facilitate Implementation Of Effective Practices) needed to take new, popular science and optimizing it in practice.
For more, join us in Washington, D.C. in November for The 2017 OPEN MINDS Technology & Informatics Institute, where my colleague, OPEN MINDS Senior Associate Sharon Hicks will present “Innovations In Consumer Technology: How To Use Tech To Increase Engagement & Improve Satisfaction.”