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Important Insights from Athena Madros at Open Minds

Executive Briefing | by | December 5, 2017

Athena Mandros
Athena Mandros

It appears we’re on the verge of moving to an era of digital treatment. It’s not like we haven’t seen web-based and smartphone-based therapies in the previous decade, we certainly have. In fact, there are over 165,000 health and medical apps on Google play and in the app store, and about 30% of the adult population owns a wearable (see The Impact Of Tech In The Future – & The Reality Of Tech In The Presentand Remaking Health Care With Wearable Technology & Digital Health – A View To The Future).

But, from a policy perspective, the FDA has finally officially recognized that many of these therapies go beyond advisory or adjunctive and will become an integral part of the treatment process. (For more on coverage of the FDA activities in this area, see Digital Health; FDA Selects Participants For New Digital Health Software Precertification Pilot Program; and Thinking Of Creating A Digital Health App?.)

What is the range of digital treatment technologies? Digital treatment technology is a broad term used to describe a technology tool that can be used to treat a consumer’s physical, behavioral, or cognitive health condition. These tech tools include mobile apps, devices that feed information into medical apps, wearables, and telehealth.

In the past few months, we have seen major digital treatments cleared by the FDA in the behavioral health space. In September, the FDA approved reSET®, a prescription mobile cognitive behavioral therapy (CBT) app for non-opioid outpatient addiction treatment. It is the first mobile application for addiction via a prescription (see FDA Approves Pear Therapeutic reSET Prescription Mobile CBT App For Outpatient Addiction Treatment). And, in November, the FDA approved Abilify MyCite, the first pill with an ingestible digital sensor to track medication adherence. The sensor records that the medication was taken and communicates that information to a mobile application, via a wearable patch (see FDA Approves Abilify MyCite® (Aripiprazole Tablets With Sensor), A Pill With Digital Sensor To Track Oral Antipsychotic Ingestion Additionally, Carrot received FDA approval for the first FDA-cleared digital smoking cessation program (see The FDA just approved the first mobile device and app to help you quit smoking). Another non-behavioral device that has received clearance is WellDoc, who received clearance for BlueStar, a diabetes management program (see WellDoc receives FDA clearance for non-prescription version of diabetes management app). In total, there are now 220+ FDA-cleared medical apps on the marketplace. And, to review what’s been cleared check out: Examples of Pre-Market Submissions that Include MMAs Cleared or Approved by FDA.

What does this mean for strategy and clinical service delivery for provider organizations? There are implications for planning, for clinical operations, for financial sustainability, and for consumer engagement. The planning implications are straightforward. Management teams need new planning capabilities—the ability to evaluate digital treatment technologies and, for those selected, recommend as appropriate. And, when using these new treatment technologies, establishing a process to use the “big data” that comes from digital treatment both in individual treatment planning and in population health management.

The operational implications are more obvious. The selected digital treatment technologies need to be integrated into existing treatment protocols and along with that integration, clinical teams need to accept and learn to excel in using these new tools. But the financial implications are more complex. Bringing in these new technologies will inherently create a “substitution effect” with technology replacing some elements of care delivered by staff changing the cost of care and price points.

Finally, these new digital treatment technologies alter an organization’s relationship (and clinical professionals’ relationship) with consumers. There is more consumer control and more consumer information transparency. Digital treatment technologies allow for real-time feedback and detailed data collection that is in the hands of consumers and direct caregivers. The treatment process and the information relies on consumer involvement in the care management process.

For most provider organization executive teams, “technology” has traditionally meant billing systems and EHRs. In the years ahead, technology will be more focused on the twin goals of population health management and consumer engagement (see How Technology Is Changing Case Management)—and be an integral part of the treatment process.

For more, join us at The 2018 Strategy and Innovation Institute in New Orleans on June 5 for the session Innovation In Addiction Treatment: The New Community-Based, Tech-Enabled Models led by Steve Ramsland, Ed.D., Senior Associate, OPEN MINDS.

You may love Bob Dylan, you may hate him – but no one who can argue that the man is a genius.  And it is further indisputable that if you like almost any “popular” record made after 1962 that you owe it to him and the path that he paved for all who followed him.  In 2012 he released an album, exactly fifty years after his first.  The album was good — not thrilling, not fabulous, but good.  In an of itself, it is an album worth listening to. That opinion isn’t based on a comparison to Blood on the Tracks or Blonde on Blonde, or any of his seminal works that laid the foundation of popular music as we know it. It’s just based on an evaluation in a moment in time.  He’s not the man or the artist he was decades ago.  It would be unfair to compare him to himself, wouldn’t it?  It would be unreasonable.  It would be unproductive.

For the last year I have been listening to the debate in the financial blog-o-spheres about Apple.  Let me throw it out there right off the bat that I am not a Tim Cook fan.  That being said, as a witness to Apple’s loss of market value and present valuation in the marketplace, I think that some of what the stock is enduring is the result of an unfair comparison of the company to itself.  I say some because I agree that Apple has not been the innovative company it was under the great genius direction of Steve Jobs.  It has recycled and facsimiled versions of existing products with new bells and whistles and some improvements at the margin; but, it has not given us the disruptive, cult like products that we learned to expect from it.  And so some significant compression of its valuation is justified.  As any stock transitions from “growth” to “value”, it will endure the same process.  It is inevitable and wholly appropriate.

I really don’t want to turn this into a complex financial argument, so in the simplest of a terms I will point out that by most widely accepted measures Apple is valued between 30%-40% ‘cheaper’ than its peers.  It’s not growing as fast as they are, it’s not perceived to be innovating as well, and its management team is not held in as high a regard.  BUT — Apple’s profitability is enviable, its products are still extremely relevant, it has over $100B in cash, it has no debt, and we all still sit on the edge of our seats wondering what they might be giving us next.  So I caution everyone not to make the mistake of comparing today’s Apple to it’s former self.  Like Dylan, it may not be the genius we once knew, but that does not mean it’s not still great.