In this presentation, the top apps and digital therapeutics for behavioral health, with a focus on stress, depression, and anxiety, will be reviewed including a summary of program offerings and patient outcomes. Strategies for embedding digital health programs as complements to traditional behavioral health treatment will be discussed. The design and results of a recent implementation of mobile app prescriptions as part of standard care in 12 clinical areas with 70 plus prescribing providers will be described. Engagement and acceptability data from patients and providers will be shared. Strategies for developing standard work and governance for this new category of behavioral health treatment will be offered. Discussion will center on how mobile health represents a high value, low-cost care transformation for the future of health care.

2. Leveraging Mobile Apps and Digital
Therapeutics to Improve Behavioral Health
Leanne Mauriello, Ph.D.
Kara Tibbe, MBA

3. 3
Source: American College of Lifestyle Medicine
Lifestyle
Medicine

4. 4
Presentation Objectives
• Express the importance of mobile health as a low-cost and high-value
component of care transformation
• Describe the qualities and outcomes of the top digital health programs for
behavioral health
• Identify how to discern effective and best in class digital health programs
• Employ strategies for embedding digital health programs as part of
behavioral health treatment plan

5. 5
What is Digital Health?
Defining digital health:
Digital health is using any form of app, wearable, software, internet or technology
to better manage health goals and outcomes. Digital health tools can be used alone by an
individual or in conjunction with medication or a medical professional
Defining digital therapeutics:
“Digital therapeutics deliver evidence-based therapeutic interventions to patients
that are driven by high quality software programs to prevent, manage, or treat a broad
spectrum of physical, mental, and behavioral conditions.”
Digital therapeutics can:
• Enhance and support current medical treatments
• Provide patients, providers, and payers with novel therapy options for unmet
medical needs
• Be used independently or in conjunction with other therapies
• Reduce reliance on certain pharmaceuticals or other therapies
• Integrate into medical guidelines and best practices

6. 6
Advantages of Digital Engagement
• Personalized
• Engaging
• Convenient
• Private
• Broad reach
• Cost-effective
• Frequent touchpoints
• Connectivity to other apps & devices
• Continuous data collection and evaluation

7. Value Proposition of Digital Health
7
Consumer
• Highly engaged in
apps, wearables, and
devices and spend
discretionary budget in
this space
• Empowers consumers
to self-monitor and
change their behavior,
thereby improving their
health
• Interested in social
aspect of being
“connected” and aware
of health trends
Clinician
• Consumers seek advice
and recommendations
from their clinician on
which apps/devices are
best
• Low-cost, scalable way to
extend care provided to
more people and offers
more continuous
interaction/care
• Important in value-based
payment arrangements for
prevention/wellness &
disease management
Payer
• Desire cost-effective,
consumer-centric, and
scalable solutions to
monitor, prevent, and
manage chronic disease
(and reduce cost of care)
• Seek digital solutions as
a way to offer wellness
programming
• Interested in offering
digital solutions to
employers to remain
innovative and
competitive

8. 8
Prevalence of Digital Engagement
• There are over
318,000 Health
Apps
• Over 340
Wearable and
Clinical
Devices

9. 9
Prevalence of Digital Engagement in the United States
• 81% of Americans
own smartphones in
2019, up from 35% in
2011.
• ¾ of U.S. adults now
own a desktop or
laptop computer, with
roughly half owning a
tablet.
• 1 in 5 Americans are
“Smartphone-only”
internet users
Smartphone Prevalence
71%
78%
90%
95%
>30,000
30,000-
49,999
50,000-
74,999
75,000+
Socioeconomic
Status96%
92%
79%
53%
18-29
30-49
50-64
65+
82%
80%
79%
White
Black
Hispanic
Ethnicity
Age

10. 10
Behavioral Health Landscape
Insomnia

11. Behavioral Health Marketplace

12. 12
Behavioral Health Landscape

13. 13
Behavioral Health and Digital Therapeutics
• Improves care
accountability
• Motivates patient to
reach goals on their
own
• Frequent touchpoints
between care
encounters
• Potential decrease in
office visits opening
access to higher risk
patients
Stand Alone
Digital Tool
+
Remote
Clinician
Support

14. 14
Value of Digital Health as Complement to Care
Clinical
Encounter
• Assess if using apps
• Identify needs and
goals
• Match digital therapy
with treatment plan
Before Clinical
Encounter
• Bridge if delayed
access for low to
moderate risk
• Initial treatment for
low risk
• Engage patient
engagement and
readiness
After Clinical Encounter
• Adjunct to
complement
treatment
• Maintain patient
engagement
• Enhance outcomes
• Maintenance
offering

15. Benefits of digital therapeutics- testimony from a
director of Care Management
Erica Auger
Director
Care Management
Spectrum Health
https://vimeo.com/361310855

16. Meditation & Mindfulness / Stress & Anxiety

17. Sample Headspace Meditation
17
https://youtu.be/c1Ndym-IsQg

18. 14%
decrease in
stress after
10 days of
using
Headspace
21%
increase in
compassion
after 3
weeks of
Headspace
12%
decrease in
stress after 3
weeks of use
among
medical
students
14%
increase in
focus after 4
weeks of
using
Headspace
16%
reduction in
burnout
among
pediatric
nurses after
4 headspace
sessions
57%
decrease in
aggression
after 3
weeks of
Headspace
Headspace Outcomes
headspace.com/science

19. Substance Abuse
19

20. Depression, Anxiety, Mental Health
20
Omada Lighthouse
• Mobile program based in Cognitive
Behavioral Therapy and mindfulness
• Evidence based with RCT outcomes
• Combine professional coaching with
interactive exercises, to overcome mental
health challenges
• Embeds intellectual property from former
mental health app Lantern

21. Depression, Anxiety, Stress
MyStrength
• CBT, motivational interviewing,
Addresses stages of change
recovery, DBT, positive psychology,
brief strategic therapy, ACT,
behavioral activation and
mindfulness
• Integrated coaching feature
• Chronic disease management

22. MyStrength Outcomes
22
Great user engagement with an
average of 6 MyStrength
sessions being completed in the
first 45 days of use.
In a large case study 74% of
users with sever depression
improved by at least one severity
category on the depression scale
within 6 months.
One study on Economic Impact of
MyStrength showed 4.8X ROI on
physical and behavioral health claims
MyStrength has 7 peer reviewed
publications, 10+ case studies and 14
White Papers

23. User Testimony
23
MyStrength: Depression, Anxiety and
Stress
“MyStrength has helped me recognize
inspiration, set goals and monitor my
feelings, health and reactions.”
“I know I can turn a negative, depressing
day or event into a calming and learning
event. I can now let go of negative
people which I could not before.”
Headspace: Meditation and Mindfulness
“I can’t even explain how much you have
helped me with a life of 69 years ruled by
depression, anxiety and perfectionism
with only some relief with medications.
Your voice alone is calming and
reassuring and the techniques have
been a meaningful force every day for
me. I have suggested your website to
others as well.”

24. Counseling and Health Coaching
24
• Lifestyle health
coaching + chronic
disease
management
• Counseling for
Behavioral Health
• Chat, email,
telephonic and
video are all
options for
connecting with a
coach
https://medcitynews.com/2014/10/latest-concierge-service-health-coaches-through-your-smartphone/vida-
healthcare-coach-screenshots/

25. Vida Outcomes- Clinical trial
25
3.23%
Total body fat
weight lost at 4
months of coaching
28.6%
Of participants in
study achieved a
weight loss of
5% or more total
body weight
49.1% of participants
that recorded high
blood pressure before
the study improved
their BP in 4 months by
one hypertensive
stage

26. Vetting Digital Health Programs
26

27. AppScript
27
Received from: IQVIA, AppScript team
https://www.iqvia.com/institute/reports/the-growing-value-of-digital-health
Industry Standard Report: “The Growing Value of Digital Health”

28. Integration of AppScript into Epic
28

29. Apps Available in Spectrum Health Formulary
29
Headspace- Stress and anxiety, meditation
Medisafe- Medication adherence and management
MyFitnessPal- Lifestyle management
Lose It!- Lifestyle management
Dr. Gregar’s Daily Dozen- Healthy eating
Pro-Change- Tobacco cessation
Ovia- Ovulation tracker
Clue- Period tracker
Squeezy- Pelvic floor/ bladder control
iUFlow- Bladder control
SpectrumHealthNow- Telemedicine
MyHealth- Patient chart

30. Patient Prescription
30

31. Mobile Health Steering Committee
31
• Purpose: Create a formulary of apps, wearables, and digital health programs.
• Multiple stakeholders from across the delivery system and the health plan help to
provide clinical and business review and oversight.
• Process

32. Celia Egan, MD
Primary Care
Spectrum Health
Benefits of AppScript- user testimonial
https://youtu.be/yD9ksl1NKgU

33. Current State: AppScript
33
Prescribing Clinicians:
Physician
Physicians Assistant
Nurse/Care Manager
Pharmacist
Dietician
Physical Therapist
Occupational Therapist
Psychiatrist
Social Worker
Tobacco Coach
Health Coach

34. Mobile Health Roadmap at Spectrum Health
34
• Add more digital behavioral health solutions to our AppScript
formulary
• Partner with payers to offer digital therapies covered by insurance
• Spread use of AppScript across the delivery system including all
behavioral health clinicians
• Integrate data feedback from digital therapies/solutions to inform
clinical care
• Build analytic dashboard to evaluate outcomes

35. Contact Information
35
Kara Tibbe, MBA
Training and Development Specialist
Kara.Tibbe@spectrumhealth.org
Leanne Mauriello, Ph.D.
Director, Lifestyle Medicine
Leanne.mauriello@spectrumhealth.org