The Medicaid and CHIP Access to Prescription Digital Therapeutics Act seeks to expand care options that can help improve health outcomes and quality of life for those facing barriers to healthcare. The Digital Therapeutics Alliance this week encouraged legislators to support its efforts to broaden access to DTx.

WHY IT MATTERS

For those with chronic and mental health conditions covered by Medicaid and the State Children's Health Insurance Program, reimbursement for digital platforms and applications that can improve health outcomes has been limited. 

The bipartisan bill, S.5238, introduced by Senators Shelly Moore Capito, R-W.Va., and Jeanne Shaheen, D-N.H., could fulfill the need for a regulatory framework by requiring Centers for Medicare and Medicaid Services to develop national coverage standards.

The act would also define the term "prescription digital therapeutic" in Medicaid and allow U.S. Health and Human Services to provide states with technical assistance as they consider coverage. 

The DTA says they welcome the action and look forward to working with a broad coalition to get it passed in Congress, because it enables clinicians to prescribe innovative new technologies like digital health devices and mHealth apps that offer value to both patients and providers.

"This legislation would establish more clarity and uniformity in how prescription digital therapeutics are covered by public programs from state to state and is a critical step toward ensuring that these evidence-based treatments get into the hands of those who need them most," said Andy Molnar, DTA chief executive officer in the alliance's announcement. 

THE LARGER TREND

The DTA noted in its statement supporting the bill that Medicaid beneficiaries face increased barriers to care during and beyond the COVID-19 pandemic.

But therapeutics like digital applications for mental health and digital care management systems can help practices scale and reach more patients with repeatable workflows and tools that automate low-touch interactions. These applications can also identify patients requiring interventions.

With some digital therapeutic products, clinicians can easily track engagement and progress directly within electronic health records and workflows, according to Bronwyn Spira, founder and CEO of Force Therapeutics. 

Spira said during a recent conversation about how digital therapeutics can improve orthopedic care and physical therapy that digital care management platforms can help address basic patient challenges – from inadequate healthcare access to poor health literacy and a lack of motivation.

"We had very little or no visibility into how patients were managing at home, and whether the patients were achieving the outcomes that mattered to them," she said, explaining that orthopedists and physical therapists lacked data to make the right care decisions – while patients lapsed in their treatment regimens or encountered cost challenges.

"That period led me to believe that evidence-based remote therapy and education could play a pivotal role in helping disadvantaged populations follow their postoperative care plan," she said.

ON THE RECORD

"Digital therapeutics hold particular value for Medicaid populations with convenient, accessible and personalized treatment options to address many unmet medical needs," said Molnar in the DTA statement.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS publication.