Software as a Drug

flying cadeuciiWhat if your spouse were a borderline Type 2 diabetic?  If you had the money, you could hire someone to follow her or him around the clock, sort of like a glorified personal trainer.  Your spouse would make sure he or she took a daily mile-long walk, did some weight training to build muscle mass and would stop you from eating ice cream or cake or drinking a glass of wine.

A good idea – but too expensive, right?

It doesn’t have to be, because a new and highly efficient modality – digital therapeutics – has entered the picture. Commonly referred to as “software as a drug,” digital therapeutics relies on software to similarly deter your spouse from becoming diabetic – in tandem with online coaches, electronic messages and the use of social networks.

Most digital health companies deploy software modules as an enhancement, or even a substitute, to a prescription drug. They are affordable and effective and poised to become a critical component of digital health, thereby substantially improving the efficiency of American healthcare. Digital therapeutics is already roughly a $500 million market and positioned to balloon into a $6 billion market, according to a research report by Goldman Sachs, supported by analysis by digital health venture firm Psilos Group.

Digital therapeutics improves health outcomes by addressing chronic conditions such as Type 2 diabetes, depression and anxiety, and drug addiction through behavioral changes, before they become worse and require elaborate treatment. This 21st century modality marries the latest developments in behavioral economics, smartphone apps, game-ification, biometric sensors, data analytics and artificial intelligence. In some cases, digital therapeutics modalities get approval from the U.S. Food and Drug  Administration.

The Problem Today with American Healthcare

America has the best doctors and the best technology but, by global standards, not particularly good outcomes. This is mostly because far too many Americans suffer from treatable chronic conditions often untreated until they require radical intervention. The U.S. would be far better off if its doctors and advanced technology were focused mostly on treating conditions that in general are not preventable, such as cancer, and simultaneously embraced methods for patients with chronic conditions to treat themselves. This is precisely the role of therapeutic therapeutics.

This new modality also will gain acceptance because it fits neatly into new ways that individuals interact with the Internet for their healthcare. Not long ago, people primarily used the web for healthcare to research medical symptoms. Today, by contrast, a majority of people already are using mobile and web to more fully interact with their healthcare.

A Digital Therapeutics Example: HealthMine

One of the pioneers of digital therapeutics is HealthMine, a Psilos -backed company that works with many employee health plans, culling data from them to identify people with chronic illnesses and offer them targeted software to self-manage their problem. HealthMine’s platform searches for irregularities such as abnormal heart rates, high glucose readings and high body mass indexes. Then HealthMine prescribes tailored recommendations from a database of 3,500 recommendations for people with suspect health.

Results have been impressive.  A three-year HealthMine study of 120,000 people enrolled in its programs found that far more than average visited doctors for preventive reasons, accounting for 10 to 20 percent fewer hospital admissions, bed days and emergency room visits in the first year.

HealthMine has since been joined by a batch of new digital health players such as Pear Therapeutics, Omada Health, Akili Interactive Labs, Canary Health and The Sync Project. In total, there are more than 50 digital therapeutics companies today, including some in stealth mode.

Another Example: Pear Therapeutics

Another example of digital therapeutics in action is Pear Therapeutics, which uses it to treat a wide range of behavioral health disorders. As is the case with HealthMine, some of its software has already been clinically validated. Pear’s digital therapies, called E-formulations, are mobile digital therapies that provide patients with a set of rewards linked to abstinence and completion of software modules.

One Pear Therapeutics product is reSET, a treatment tool used in conjunction with face-to-face therapy to treat substance abuse disorders. More than 500 patients with this problem in 10 treatment centers were split into two camps for 12 weeks of testing. One camp received traditional face-to-face therapy only. The other camp received a reduced amount of therapy plus reSET. Abstinence was measured twice weekly.

Among patients who tested positive for drug use at the start of the study, 27 percent of reSET users were abstinent in study weeks nine through 12, compared to only 3 percent of patients in the same period who relied on face-to-face therapy alone.

Other Pear software-based clinical interventions are under development for the treatment of insomnia, traumatic brain injury, attention deficit disorder, schizophrenia, depression and acute and chronic pain.

Where is all this heading? Happily, traditional fee-for-service healthcare, a persistent blockade in the quality of the American healthcare system, is being replaced by value-based medicine and its emphasis on good outcomes and lower prices. Digital therapeutics will become a key component of value-based medicine’s road to success, demonstrating new ways to effectively marry healthcare and cutting-edge technology.

Joe Riley is a managing partner of Psilos Group and co-author of the firm’s OUTOOK 2016, a white paper about digital therapeutics.