Reimbursement of Apps for Mental Health: Findings From Interviews.

BACKGROUND: Although apps and other digital and mobile health tools are helping improve the mental health of Americans, they are currently being reimbursed through a varied range of means, and most are not being reimbursed by payers at all. OBJECTIVE: The aim of this study was to shed light on the state of app reimbursement. We documented ways in which apps can be reimbursed and surveyed stakeholders to understand current reimbursement practices. METHODS: Individuals from over a dozen stakeholder organizations in the domains of digital behavioral and mental health, care delivery, and managed care were interviewed. A review of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCSPCS) codes was conducted to determine potential means for reimbursement. RESULTS: Interviews and the review of codes revealed that potential channels for app reimbursement include direct payments by employers, providers, patients, and insurers. Insurers are additionally paying for apps using channels originally designed for devices, drugs, and laboratory tests, as well as via value-based payments and CPT and HCSPCS codes. In many cases, it is only possible to meet the requirements of a CPT or HCSPCS code if an app is used in conjunction with human time and services. CONCLUSIONS: Currently, many apps face significant barriers to reimbursement. CPT codes are not a viable means of providing compensation for the use of all apps, particularly those involving little physician work. In some cases, apps have sought clearance from the US Food and Drug Administration for prescription use as digital therapeutics, a reimbursement mechanism with as yet unproven sustainability. There is a need for simpler, more robust reimbursement mechanisms to cover stand-alone app-based treatments.

A Promising New Strategy to Improve Treatment Outcomes for Patients with Depression.

Each year, ineffective medical management of patients with mental illness compromises the health and well-being of individuals, and also impacts communities and our society. A variety of interrelated factors have impeded the health system's ability to treat patients with behavior health conditions adequately. A key contributing factor is a lack of objective markers to help predict patient response to specific drugs that has led to patterns of "trial and error" prescribing. For many years, clinicians have sought objective data (eg, a laboratory or imaging test) to assist them in selecting appropriate treatments for individual patients. Electroencephalogram (EEG) findings coupled with medication outcomes data may provide a solution. "Crowdsourced" physician registries that reference clinical outcomes to individual patient physiology have been used successfully for cancers. These techniques are now being explored in the context of behavioral health care. The Psychiatric EEG Evaluation Registry (PEER) is one such approach. PEER is a clinical phenotypic database comprising more than 11,000 baseline EEGs and more than 39,000 outcomes of medication treatment for a variety of mental health diagnoses. Collective findings from 45 studies (3130 patients) provide compelling evidence for PEER as a relatively simple, inexpensive predictor of likely patient response to specific antidepressants and likely treatment-related side effects (including suicidal ideation).

A Tipping Point for Measurement-Based Care.

(Reprinted with permission from Psychiatric Services, 2017; 68:179-188).

A Tipping Point for Measurement-Based Care.

OBJECTIVE: Measurement-based care involves the systematic administration of symptom rating scales and use of the results to drive clinical decision making at the level of the individual patient. This literature review examined the theoretical and empirical support for measurement-based care. METHODS: Articles were identified through search strategies in PubMed and Google Scholar. Additional citations in the references of retrieved articles were identified, and experts assembled for a focus group conducted by the Kennedy Forum were consulted. RESULTS: Fifty-one relevant articles were reviewed. There are numerous brief structured symptom rating scales that have strong psychometric properties. Virtually all randomized controlled trials with frequent and timely feedback of patient-reported symptoms to the provider during the medication management and psychotherapy encounters significantly improved outcomes. Ineffective approaches included one-time screening, assessing symptoms infrequently, and feeding back outcomes to providers outside the context of the clinical encounter. In addition to the empirical evidence about efficacy, there is mounting evidence from large-scale pragmatic trials and clinical demonstration projects that measurement-based care is feasible to implement on a large scale and is highly acceptable to patients and providers. CONCLUSIONS: In addition to the primary gains of measurement-based care for individual patients, there are also potential secondary and tertiary gains to be made when individual patient data are aggregated. Specifically, aggregated symptom rating scale data can be used for professional development at the provider level and for quality improvement at the clinic level and to inform payers about the value of mental health services delivered at the health care system level.

After parity--what's next.

A new law prohibiting unequal treatment limits and financial requirements for mental health and substance abuse (MH/SA) benefits establishes critical protections for 113 million Americans. The new parity law doesn't mandate coverage for MH/SA treatment and anticipates management of the benefit. Given these features, clear regulations mapping the intent of the law are critical. Education regarding the costs of untreated or ineffectively treated MH/SA conditions is needed to encourage comprehensive coverage, because academic performance and worker productivity are at stake. As health care reform proceeds, we must use the new law to reinforce the centrality of mental health to overall health.