Wisconsin health plan tests digital health treatment for panic disorder

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The Children’s Community Health Plan uses digital therapy to improve patient engagement and offer members struggling with panic disorder an alternative to medication or in-person emergency treatment.

Health care providers and payers often seek alternatives to drugs in the treatment of chronic conditions, especially those experienced by children. An increasingly popular example is digital therapies, which can be delivered virtually, through an mHealth app, when and where needed.

Community Child Health Plan (CCHP) is seeing success with such treatment for members struggling with PTSD and Panic Disorder. The Milwaukee-based health management organization, a subsidiary of Wisconsin for kidsrecently made a digital health platform developed by Freespira available to its 150,000 members, approximately 60% of whom are children, free of charge and has found success with approximately 70% of people who have used the platform.

“We have been pleasantly surprised by the number of members who have committed to treatment,” says Marc Rakowskithe president of the health plan.

The key word is “committed,” and it’s a word that healthcare organizations like CCHP have long struggled with in chronic care management. People often struggle to stick to treatment over a long period of time – and with chronic conditions, that time can be a lifetime. Patients get tired, lose interest, treatments drop, and the risk of negative health outcomes increases.

A digital health alternative to drugs

digital therapy, defined by the Digital Therapeutics Alliance as “medical interventions delivered directly to patients through evidence-based, clinically evaluated software,” addresses the dilemma of patient engagement. Advocates say these treatments, delivered through mHealth apps, devices and even video games, have the potential to hold patients’ attention longer and make them more inclined to manage their healthcare.

With CCHP, the motivation to use this treatment stems from a statistic from the Centers for Disease Control and Prevention (CDC) that nearly 3 million children have been diagnosed with a serious emotional or behavioral health condition during the pandemic, and that approximately 6% of children aged 6 to 17 now suffer from these conditions.

Mark Rakowski, chair of the Children’s Community Health Plan. Photo courtesy CCHP.

“We needed another tool in our toolbox,” Rakowski says. “It is an alternative treatment to traditional psychotherapy or pharmacology, which can sometimes have side effects. It gives us a chance to try something new.”

The Freespira platform treats panic disorder through breathing, based on the theory that the underlying physiological cause is related to breathing irregularities and hypersensitivity to carbon dioxide. Using a respiratory sensor, tablet, and personalized app, users undergo two 17-minute treatments per day to normalize respiratory patterns for a 28-day period.

After a year of use, CCHP officials reported that 68% of nearly 250 people who used digital therapeutics experienced “clinically significant” reductions in symptoms associated with PTSD and panic disorder.

This, in turn, means less reliance on prescription drugs, fewer visits to the doctor or hospital to treat emergencies like panic attacks, and improved quality of life, which has a number advantages downhill. For payers, the ROI can be seen reduced healthcare costs and better clinical outcomes.

Finding a path to sustainability

Rakowski says CCHP looked at the data before agreeing to support the Freespira platform, “and that was really key.” But the health plan is going to need its own data to expand and sustain the program.

Although CCHP will initially provide Freespira Digital Therapy for free, this will not last forever. Because a large percentage of the health plan’s member base is on Medicaid, they would like the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement. This, in turn, would convince more healthcare providers to prescribe or recommend the treatment to their patients.

“We can cover the cost for now because we are seeing a return on investment,” Rakowski points out. “But will that stick over time? Our future payouts are based on claims usage…and we’ll need longitudinal data to prove it.”

And long-term sustainability, he says, will be tied to patient engagement.

An important aspect of this treatment is the adherence of the provider. Having a doctor prescribe or recommend this treatment (as opposed to a health plan suggesting or recommending it) goes a long way to improving patient engagement. Patients trust their doctors and will listen to them, Rakowski says, and they’ll be more likely to stay in touch with their doctors about treatment.

“We don’t want to get in the way of that relationship,” he says.

And like CMS, doctors need to see proof that a digital therapy will work for their patients before supporting it. And this value can work both ways.

“They want to make sure the technology itself is given such scrutiny,” Rakowski says.

Rakowski says these home treatments — CCHP also works with Propeller Health, a digital health company focused on respiratory issues like asthma and COPD — also offer benefits to healthcare providers, in that they can manage their patients more easily on a digital health platform. Doctors not only get a link to the patient’s life between scheduled office visits, but they get data that helps them see how the patient is doing, how the current treatment plan is working or not working, and what day-to-day events or factors Stress could cause panic attacks and other disturbing results.

This is especially important in the treatment of a behavioral health problem. Rakowski says patients living with these health conditions are still stigmatized and are less likely to see a doctor when they need to. They may also have difficulty opening up to a doctor about their mental health or describing how they feel or act.

“You just have to get people to pick up their phones [and call] is a challenge,” says Rakowski.

A digital therapy should not only be functional, but easy and attractive enough that someone will want to use it and continue to use it when needed. A treatment like Freespira fits that bill, while helping patients become more comfortable with managing their health.

Rakowski says CCHP plans to increase the number of members using the Freespira platform, and he hopes the numbers continue to look good. They’ve had good luck and bad luck with digital health so far, but the success of Freespira and Propeller Health is giving administrators ideas on what other treatments to try. They would like to find an mHealth app, he says, that will help new mothers and mothers-to-be with maternity care.

“Implementation takes time,” he says, “but for us as a health plan, we’re seeing what we’ve done with this so far and the difference we’re making. We’re changing lives people.”

Eric Wicklund is the technology editor for HealthLeaders.

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