Two Peas in a Pod: Patient and Provider DTx Adoption Barriers

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The digital therapeutic (DTx) landscape is rapidly evolving with DTx securing a record-breaking $3.4B across 122 investments in 2021, up 133% from the previous year. DTx funding has increased year on year and is estimated to reach $56B by 2025. Despite this large financial backing in recent years, questions arise; are we seeing increased adoption of these digital technologies? Will they soon become the new treatment of choice for individuals? While COVID-19 may have accelerated adoption of digital technologies due partly to the FDA’s temporarily relaxed guidelines allowing temporary approval of DTx treating psychiatric disorders, it appears patient demand is still low and adoption rates vary by geography. 

Pear therapeutics, a pioneer in the DTx space, recently released its performance metrics for 2021 stating more than 550 providers wrote more than 14,000 prescriptions for their three commercial products reSET®, reSET-O®, and Somryst®. Additionally, more than 30 organizations covering 31.7M lives are now providing access to Pear’s DTx, as well as being listed on major national product formularies, including two (Remedy One & Serve You Rx) of the top five pharmacy benefit managers (PBMs). In Germany, 50,000 DiGA prescriptions were recorded over the period of a year, however this is quite low when you take into account the 73 million citizens insured with a statutory health insurer that reimburses their use. DTx available through the DiGA route are reimbursable, so it is surprising uptake isn't more substantial, indicating there are likely other adoption factors at play here. Other geographies lagging behind in adoption of DTx include emerging countries of the APAC region where digital health regulations are in their infancy. 

Many barriers to DTx adoption exist including regulatory issues, technical considerations, general population awareness and reimbursement challenges. However, there are really two key stakeholders who are essential for driving adoption of these digital interventions; the patient and provider, which we will take a deeper look at in this blog. 

The Patient

Patient adoption is really central to the success of DTx – at the end of the day they are the ones using these novel medical interventions. First and foremost, knowledge and awareness of DTx among the patient population remain a key barrier to adoption. In a recent survey conducted by HealthXL (where eligible participants were located in the U.S., UK, EU or APAC), it was found that 42% of respondents classified the Apple watch as a digital therapeutic while only a mere 12% stated they would seek out a DTx as a way to treat an existing disease. This clearly highlights the challenges a DTx company faces in raising awareness of their products. Patients may also be concerned about data security, particularly with their medical data. DTx companies need to factor in this element and try to broker patient trust, in particular as data security laws can vary between countries.

Often we hear about medication adherence problems in patients, however this problem is not limited to pharmacological treatments. mHealth apps often have significant dropout rates, with users not adhering to them as intended and HCPs have echoed this potential adherence issue with DTx. If there are no obvious follow ups such as reordering a prescription or reviews to indicate treatment completion, how do HCPs know the DTx has been used consistently? Another barrier to adoption in patients which is possibly contributing to low adherence rates, is technology literacy of patients. A central factor of consideration in the implementation of DTx is that the end user has adequate technology and the ability to operate this technology. As DTx are primarily delivered on phones or tablets, only patients who can afford and operate these items can benefit. Older individuals who may not be as tech savvy as the younger population, are often eager to adopt new technologies but lack proper instruction and support in doing so. Therefore, it’s important DTx companies factor in these diverse patient populations and implement proper onboarding programs for all users.

Lastly, cost is an obvious barrier for patients. Pear Therapeutics DTx Somyrst for insomnia is priced at $899 for 9 weeks which is quite substantial for a short period of time and some users may not be eligible for reimbursement. If out-of-pocket spend is too high for patients, this will impede uptake and adoption. Patient affordability is a key determinant in adoption and reimbursement pathways are central to overcoming this challenge. 

The Provider

Providers face many challenges in the uptake of DTx and, similarly to patients, their adoption of these solutions is really crucial to their success. They are the primary ‘marketer’ of the DTx to patients and patients tend to trust and use solutions recommended by their HCP. 

Similarly to patients, provider awareness of the benefits and availability of DTx is limited. Furthermore, technology literacy may also be a challenge. Providers require technical training around the use of DTx and also clinical guidelines to refer to for appropriate implementation and prescription of DTx.  Without this DTx advocacy building, providers will struggle to adopt these new technologies.

Our HealthXL community insights show that HCP burnout is another big barrier to adoption. Further, HCPs are generally interested in embracing new technologies, but what's in it for them? 

Time, revenues and quality of care are really important for HCPs. Hence, before they even consider prescribing a DTx product, it is critical that they see results showing the DTx will:

 1) save them time, 

2) not be revenue negative 

and 3) actually improve their patients' care.

Workflow integration is another challenge. As mentioned, providers are already burnt out and do not want to deal with systems that are not already embedded into their workflows. If the DTx is on another platform that doesn’t feed into existing workflows, this will create additional work and strain for HCPs. Solutions should integrate seamlessly with existing clinical workflows and electronic health records. Solutions that save time and enable this will gain traction. Another cause for HCP concern is around patient data security and the amount of data generated by the DTx. Is the provider required to review all this data? Will they be liable if they don’t? Many of the answers for these questions are not concrete. 

Variability of patient populations in diseases is also a challenge for considering the selection of the optimal digital solution for providers. For example, in chronic diseases such as diabetes, younger patients may have different needs and challenges versus older patients. This needs to all be taken into account when designing and marketing these DTx. 

Interestingly, Akili, a pioneer in the digital therapeutics space recently filed an S-4 detailing significant ($41M) financial losses for the first nine months of 2021, while revenue for that period was only $377,000. Although Akili’s product EndeavorRx has only been launched in small pilots before a broader market rollout this year, it still highlights the challenges DTx companies face in the fight for patient and provider adoption. Physician and patient education is really central to achieve this broader market acceptance of DTx.

Future Gazing

Despite the fact there is alot of industry and financial support for DTx, there are still many roadblocks to winning over patients and providers, however we are on the right track. Provider education programs such as Weill Cornell Medicine’s Center for Virtual Care, the  Boehringer Ingelheim DH academy, and the The Topol Programme for Digital Fellowships in Healthcare in the UK, have recently been established which will likely aid in increasing provider awareness and education. There also may be scope for improving the education of students in medical school around digital health technologies. Countries are taking inspiration from each others' reimbursement pathways (France plans to replicate Germany’s DiGA pathway), while Pear therapeutics' recent partnership with MassHealth will become the first Medicaid program to reimburse prescription digital therapeutics. These solutions and programs give promise to the ever exciting field of DTx which have the potential to expand access to care, generate valuable real world data insights and decrease healthcare costs.