The next blockbuster therapy is probably already in your pocket or purse.
The FDA recently approved the first prescription digital therapy, Pear’s Reset app and program, which is focused on substance abuse. Others are likely to follow. That means your next trip to the doctor could include a prescription for a mobile app in addition to, or instead of, medicine.
Digital therapy represents a powerful yet provocative new idea in health care. Software brings a precision to therapy and with it an ability to personalize treatment. This gives digital therapy a big role to play as we transition to value-based care.
But can software be a therapy all by itself? Or, as MIT’s Technology Review recently asked, “Can ‘digital therapeutics’ be as good as drugs?”
These aren’t purely academic or technological questions. They are ones we need to take seriously as we look to curb our country’s dependence on prescription drugs and find better, more effective options for treatment. At the same time, the health care industry continues to embrace a focus on prevention. The emphasis on wellness and health management has driven new thinking about how to engage people well before they become patients.
Where we are today
Several companies are playing out this argument. Omada and Virta are often cited, along with Ginger.io, Triggr, Propeller, Livongo, AbleTo, and my company, Vida Health.
The solutions they offer are now emerging from pilots and testing, and we’re beginning to see enormously positive outcomes from digital therapy.
As the Wall Street Journal reported, “the emerging field of digital medicine — a combination of remote monitoring, behavior modification and personalized intervention overseen by the patients’ own doctors — can improve outcomes in some of the most costly and tough-to-manage categories such as diabetes, heart disease, and lung disease.”
In one recent study, digital therapy and tailored health programs helped drive down body weight and blood pressure. Such tools can be especially effective for diabetes prevention and management. Doctors prescribing digital therapies are seeing increased patient activation, medication adherence, and reduced hospital readmissions.
A growing body of research on digital therapies is validating what physicians have long known: that environment and behavior play substantial roles in most preventable diseases, and that software-based digital therapy can consistently and positively influence both.
Focus on chronic disease
Most digital therapies today focus on complex chronic conditions, like obesity, diabetes, and mental illness. Chronic care is a good fit for digital therapies for several reasons.
Money. Chronic disease accounts for a disproportionate share of health care costs in the United States — more than $2 trillion dollars year and 86 percent of all health care costs. Elevated glucose levels associated with prediabetes and diabetes alone cost our country more than $322 billion annually. Payers, self-insured companies, accountable care organizations, and patients themselves are all highly motivated to reduce costs. By reducing the burden of chronic diseases, digital therapies can help create a rare win-win in health care.
No cure. Although most chronic diseases have no “cure” in the classic sense, the majority of cases are preventable. But the active day-to-day management, continuous care model, and data required to prevent these diseases elude us today. As a result, patients (and their doctors) are often willing to try new things.
Daily behaviors matter. For most chronic diseases, lifestyle changes can beneficially affect biology in both small and large ways. From migraine to obesity, high blood pressure, depression, anxiety, sleep apnea, or diabetes, success is often achieved when a patient can control the condition by developing new routines. That’s where digital therapy comes in. Software-based interventions provide a continuous feedback loop that is necessary when building the small daily habits that can have an outsized impact on health and quality of life.
Overcoming disease should be our indicator of success
There are two main categories of digital therapy today.
Single disease focus. Some digital therapies focus on a single chronic disease, like diabetes, high blood pressure, obesity, or depression. Companies in this space include Omada (pre-diabetes), Livongo (diabetes), Hello Heart (hypertension) and Ginger.io (mental health).
Wellness. Others are designed for general health and wellness. These help individuals live healthier lifestyles by getting into an exercise routine or shifting to a plant-based diet. They aim to help individuals reduce their overall risk of developing a chronic disease. Users of apps in this category tend to be comparatively healthy. Companies in this space include MyFitnessPal, Noom, Farewell, and Weight Watchers.
Both types of digital therapy are useful, but there needs to be a bridge between the two. Let me explain what I mean.
General health and wellness apps are great, but they only work for a relatively small, self-motivated group of people. These apps often don’t sustain long-term behavior change and there’s little evidence that they can, on their own, drive measurable outcomes for people who need them most.
Digital therapies focused on single diseases, on the other hand, can be quite effective at addressing the chronic condition they were built to treat in certain “cookie cutter” cases. But they miss an important fact about chronic diseases: most of them are the product of more than one underlying condition. Physical and mental health are entwined along a continuum that makes it difficult to effectively treat one without at least acknowledging the other. For instance, 43 percent of people with depression are obese; obese people are 55 percent more likely to depressed. Factors of one disease can feed into the other, creating a vicious cycle.
If we treat just the mind or just the body, we’re failing people in a profound way.
Why you should care
My friend Daphne Kis, whose Litmus Health startup employs machine learning to make sense of behavioral data in clinical trials, uses the phrase “good days and bad days” to describe the opportunity in front of us all, both inside and out of the lab.
If digital therapy can meaningfully create for users many more good days than bad ones, then software can convincingly improve the daily quality of life for millions of people, not to mention drive billions of dollars in system-wide savings.
Digital therapies aren’t yet seeing SoulCycle and Orangetheory numbers, but they are getting there. We are seeing larger and larger numbers of individuals voluntarily enlisting in and paying for outcomes made possible by software.
If it’s true that the average American taps, types, swipes, or or otherwise engages with his or her smartphone an astonishing 2,617 times per day, we ought to be able to leverage our national obsession with pocket computers for dramatically better health. It’s amazing to think that the path to a fundamentally healthier digestive system is no harder to use than Facebook and no more expensive than a respectable coffee habit, but it’s entirely possible.
Stephanie Tilenius is the founder and CEO of Vida Health.
Updated to correct Americans’ engagement with their smartphones