Reimbursement of Apps for Mental Health: Current Practices and Potential Pathways

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.

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.

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.

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.

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.

The full article can be downloaded below.  

EXPLORING CHALLENGES AND OPPORTUNITIES IN CYBERSECURITY RISK AND THREAT COMMUNICATIONS RELATED TO THE MEDICAL INTERNET OF THINGS (MIOT)

As device interconnectivity and ubiquitous computing continues to proliferate healthcare, the Medical Internet of Things (MIoT), also well known as the, Internet of Medical Things (IoMT) or the Internet of Healthcare Things (IoHT), is certain to play a major role in the health, and well-being of billions of people across the globe. When it comes to issues of cybersecurity risks and threats connected to the IoT in all of its various flavors the emphasis has been on technical challenges and technical solution. However, especially in the area of healthcare, there is another substantial and potentially grave challenge. It is the challenge of thoroughly and accurately communicating the nature and extent of cybersecurity risks and threats to patients who are reliant upon these interconnected healthcare technologies to improve and even preserve their lives. This case study was conducted to assess the scope and depth of cybersecurity risk and threat communications delivered to an extremely vulnerable patient population, semi-structured interviews were held with cardiac medical device specialists across the United States. This research contributes to scientific data in the field of healthcare cybersecurity and assists scholars and practitioners in advancing education and research in the field of MIoT patient communications.

The full article can be downloaded below.  

Willingness to Participate in Health Information Networks with Diverse Data Use: Evaluating Public Perspectives

Health information generated by health care encounters, research enterprises, and public health is increasingly interoperable and shareable across uses and users. This paper examines the US public’s willingness to be a part of multi-user health information networks and identifies factors associated with that willingness.

Using a probability-based sample (n = 890), we examined the univariable and multivariable relationships between willingness to participate in health information networks and demographic factors, trust, altruism, beliefs about the public’s ethical obligation to participate in research, privacy, medical deception, and policy and governance using linear regression modeling.

Willingness to be a part of a multi-user network that includes health care providers, mental health, social services, research, or quality improvement is low (26 percent–7.4 percent, depending on the user). Using stepwise regression, we identified a model that explained 42.6 percent of the variability in willingness to participate and included nine statistically significant factors associated with the outcome: Trust in the health system, confidence in policy, the belief that people have an obligation to participate in research, the belief that health researchers are accountable for conducting ethical research, the desire to give permission, education, concerns about insurance, privacy, and preference for notification.

Our results suggest willingness to be a part of multi-user data networks is low, but that attention to governance may increase willingness. Building trust to enable acceptance of multi-use data networks will require a commitment to aligning data access practices with the expectations of the people whose data is being used.

The full article can be downloaded below.

Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice

This review highlights core components of successful interventions showing positive clinical and/or humanistic outcomes. Whilst it was difficult to directly correlate individual strategies to outcomes and effectiveness, there was a clear distinction of strategies across the conditions studied. This review provides encouraging groundwork for the design and evaluation of practical strategies for evidence-based practice and the construction of self-management support processes in primary healthcare practice. This review may assist in determining the breadth and focus of the support primary care professionals provide. Application of a theoretical perspective provides a strong base for the development of SMS interventions. The developed model sets the foundation for the design and evaluation of practical strategies for the construct of self-management support in primary healthcare practice. These results may be used to justify additional research investigating self-management interventions delivered in the primary care setting. In response, primary care providers can begin to deeply reflect on current practice and become involved in a dialogue to improve self-management support. Critically, these results should stimulate informed discussion for the future delivery of self-management support in primary care and the requirements for upskilling healthcare providers to effectively support patients in this collaborative process.

The full article can be downloaded below.  

Physician aims to link artificial intelligence with medical practices

As a former women’s health medical practitioner, Dr. Michael Dent is at his core a physician on a mission to save lives. But rather than treating patients individually, he’s out to save them on a global scale.

That was his goal when he founded Fort Myers-based NeoGenomics in 2002: helping to grow the cancer diagnostics lab company from a $300,000 capital investment into publicly held company with $277 million in revenue in 2018. He says his newest venture, Bonita Springs-based HealthLynked, has even greater potential.

HealthLynked is first and foremost a technology company with an emphasis on health care by linking patients with providers on multiple levels through a cloud-based software platform, Dent, 55, says. 

The company's system is capable of merging patients’ health records from a variety of sources into a comprehensive, portable, accurate health record instantly accessible by participating doctors who sign on to have the HealthLynked hub placed in their offices. Free to patient members, the service not only makes continually updated records accessible by physicians but also tracks every aspect of their patients’ visit.

And soon, an under-development artificial intelligence component will even provide diagnostic information based on factors including patient history, geography, environmental exposures and symptoms, providing the patient voluntarily maintains the profile.

The mission? Manage care, head off health issues before they present and create a connection beneficial to both patients and their providers. “We're not looking to change the dynamic of the doctor-patient interaction; we're looking to augment it,” says Dent, HealthLynked Chairman and CEO. “We’re looking to supplement, not replace.”

The full Business Observer article can be viewed at this link. 

Drugs And Blockchains

For decades, prescriptions have been written on paper. While this method is certainly easier for doctors, it presents many risks which need to be mitigated. The use of e-prescribing is up 500% in the U.S. since 2015. Though the UK and Europe are lagging in adoption, there is a significant drive to make Electronic Prescribing Systems (EPS) the norm.

International evidence shows that EPS may improve the safety of inpatient medicines management processes, reduce medication errors and, to a lesser extent, reduce adverse drug events. However, unintended consequences, including new errors, may occur. Evidence on the effects of EPS on workflow is limited and in my experience, e-prescribing can add significant time and administrative burden for busy doctors.

The full Forbes article can be viewed at this link.  

Smart wearables to unlock the next level of precision medicine

Wearables have come a long way from being merely entertaining to bringing in tangible health benefits.

Early on, bands with basic functionality were mostly appreciated by fitness enthusiasts and professional athletes. A few years later, the variety and capabilities of wearables evolved way beyond counting steps taken and calories burnt. Next generations of smart clips, rings and watches expanded their data collection and analytical abilities toward overall health and activity awareness. They began identifying individual patterns related to the user’s mood, sleep quality and vitals.

As soon as wearables became more functional, they evolved from the “sports-only” category to personal smart gear. Such democratization surged the adoption and attracted multiple user groups with goals beyond explicit association with sports and fitness.

The full Mobi Health News article can be viewed at this link.  

The Truth About Painkiller Addiction

In the early days of the opioid crisis, public officials had reasons to blame it on all the pills. News stories featured people who, to the shock of their neighbors and loved ones, had died unexpectedly of a drug overdose. In an emergency, authorities do what they can with the tools at hand. In tightening controls on doctors who prescribed pain relievers, state and federal agencies were focusing on the aspect of the problem most subject to regulatory intervention.

To some degree, that strategy worked. According to the Centers for Disease Control and Prevention, overdose deaths declined by about 5 percent in 2018—a dip attributable almost exclusively to fewer deaths from oxycodone, hydrocodone, and other prescription opioids. (Fentanyl deaths are still climbing.) Now that the fever of the opioid crisis may be breaking, Americans can revisit some of the stories we have told ourselves about the role of prescription medication in the crisis.

Did policy makers and public-health experts correctly assess who was at risk of becoming addicted to opioid medications? Were their views on the addictive potential of such drugs realistic? Did they anticipate the consequences of policies devised to constrain doctors from overprescribing? In retrospect, policy makers seriously misjudged the answers to these questions, overestimating the risk that these drugs posed to the average patient while simultaneously doing too little to urge clinicians to identify those most vulnerable to addiction. The best time to correct course is now—while the opioid problem still commands public attention, and before the restrictions imposed at the height of the crisis harden into permanent practice.

The full article from The Atlantic can be viewed at this link.  

The Futures of eHealth: Social, Ethical, and Legal Challenges

Looking into the futures of eHealth? The title of this publication might seem quite presumptuous at first. Its objective, however, is to serve a much more modest purpose, in that it strives to take a look at potential, likely, desired, anticipated or feared futures of digital health technologies and practices. When analysing the opportunities and risks associated with them as well as the social, legal and ethical challenges they might pose, what we also see in the process are the expectations and promises projected onto them.

eHealth or “digital health”, according to the World Health Organization’s European Office, “involves a broad group of activities that use electronic means to deliver health-related information, resources and services: it is the use of information and communication technologies for health” (World Health Organization 2017). As far as current developments and technological solutions are concerned, the WHO has further identified the following areas:

• Electronic health records and interoperability of data;
• Mobile health or mHealth;
• Telehealth, where a patient can consult with a healthcare worker using Skype or even a regular telephone;
• Wearable technologies (fitness trackers, medical devices, etc.) and
• Technologies to support integrated care (WHO 2017).

Looking into the futures of anything always involves creating narratives. Rather unsurprisingly, the WHO’s definition characterises the role of technology use as entailing “strengthening health systems and health information systems” (World Health Organization 2017), a narrative of opportunity. These promises of eHealth are embedded in and reflective of much larger discourses that are often associated with (digital) technologies, which are mainly seen as a remedy to existing social problems. These discourses often centre around terms such as “empowerment”, “democratic potential”, “unifying cross-border force”, “special care for vulnerable groups” or “bridging distances”. And, indeed, there is an abundance of opportunities in digital health solutions that are directly associated with these technologies and practices.

The full paper can be downloaded below.  

Improving Data Privacy Using Fuzzy Logic and Autoencoder Neural Network

Data privacy is a very important problem to address while sharing data among multiple organizations and has become very crucial in the health sectors since multiple organizations such as hospitals are storing data of patients in the form of Electronic Health Records. Stored data is used with other organizations or research analysts to improve the health care of patients. However, the data records contain sensitive information such as age, sex, and date of birth of the patients. Revealing sensitive data can cause a privacy breach of the individuals. This has triggered research that has led to many different privacy preserving techniques being introduced. Thus, we designed a technique that not only encrypts / hides the sensitive information but also sends the data to different organizations securely. To encrypt sensitive data we use different fuzzy logic membership functions. We then use an autoencoder neural network to send the modified data. The output data of the autoencoder can then be used by different organizations for research analysis.

The full article can be downloaded below.