Wisconsin Health Plan Tests Digital Health Treatment for Panic Disorder

The Children's Community Health Plan is using a digital therapeutic to improve patient engagement and give members dealing with panic disorder an alternative to medication or emergency in-person treatment.

Healthcare providers and payers often look for alternatives to medication in treating chronic conditions, especially those experienced by children. One increasingly popular example is digital therapeutics, which can be delivered virtually, though an mHealth app, when and where needed.

The Children's Community Health Plan (CCHP) is seeing success with one such treatment for members dealing with PTSD and panic disorder. The Milwaukee-based health management organization, an affiliate of Children's Wisconsin, recently made a digital health platform developed by Freespira available for free to its 150,000 members, roughly 60% of which are children, and saw success in roughly 70% of the people who used the platform.

"We've been pleasantly surprised by the number of members who have engaged in treatment," says Mark Rakowski, the health plan's president.

The key word is "engaged," and it's one that healthcare organizations like CCHP have long struggled with in chronic care management. People often have a difficult time sticking with a treatment over a lengthy period of time—and with chronic conditions that time might be a lifetime. Patients get tired, lose interest, the treatments fall off, and the chances of negative health outcomes shoot upward.

A Digital Health Alternative to Drugs

Digital therapeutics, defined by the Digital Therapeutics Alliance as "medical interventions delivered directly to patients through evidence-based, clinically evaluated software," takes aim at the patient engagement dilemma. Advocates say these treatments, delivered via mHealth apps, devices, even video games, have the potential to hold patients' attention longer and make them more inclined to manage their healthcare.

With CCHP, the motivation to use this treatment stems from a statistic from the Centers for Disease Control and Prevention (CDC) that nearly 3 million children have been diagnosed with a serious emotional or behavioral health condition during the pandemic, and that roughly 6% of children ages 6–17 now experience those health issues.

Children's Community Health Plan President Mark Rakowski. Photo courtesy CCHP.

"We needed another tool in our toolbelt," says Rakowski. "This is an alternative treatment to traditional psychotherapy or pharmacology, which can sometimes have side effects. This gives us a chance to try something new."

The Freespira platform addresses panic disorder through breathing, based on the theory that the underlying physiological cause is tied to breathing irregularities and a hypersensitivity to carbon dioxide. Through a breathing sensor, tablet, and customized app, users undergo two 17-minute treatments a day to normalize breathing patterns for a 28-day period.

After one year of use, CCHP officials reported that 68% of the nearly 250 people who used the digital therapeutic experienced "clinically significant" reductions in symptoms associated with PTSD and panic disorder.

This, in turn, means less of a reliance on prescription medications, fewer visits to the doctor's office or the hospital to treat emergencies like panic attacks, and an improvement in quality of life, which carries with it a number of downhill benefits. For payers, the ROI is seen in reduced healthcare costs and better clinical outcomes.

Finding a Path to Sustainability

Rakowski says CCHP reviewed the data before agreeing to support the Freespira platform, "and that was really the key." But the health plan is going to need its own data to scale up and sustain the program.

While CCHP is initially providing the Freespira digital therapeutic free of charge, that won't last forever. Because a large percentage of the health plan's member base is on Medicaid, they'd like the Centers for Medicare & Medicaid Services (CMS) to offer reimbursement. That, in turn, would convince more care providers to either prescribe or recommend the treatment to their patients.

"We can cover the cost for now because we are seeing ROI," Rakowski points out. "But will that remain over time? Our future payments are based on claim utilization … and we're going to need longitudinal data to prove that."

And long-term sustainability, he says, will be tied to patient engagement.

An important aspect of this treatment is provider buy-in. Having a doctor prescribe or recommend this treatment (as opposed to having a health plan suggest or recommend it) goes a long way toward improved patient engagement. Patients trust their doctors and will listen to them, Rakowski says, and they'll be more inclined to stay in touch with their doctors about the treatment.

"We don't want to get in the way of that relationship," he says.

And like CMS, doctors need to see the proof that a digital therapeutic will work for their patients before supporting it. And that value can work both ways.

"They want to make sure that the technology itself has that level of scrutiny," Rakowski says.

Rakowski says these home-based treatments—CCHP also works with Propeller Health, a digital health company focused on breathing problems like asthma and COPD—offer benefits to care providers as well, in that they can manage their patients more easily on a digital health platform. Doctors not only gain a link to the patient's life between scheduled visits to the office, but they get data that helps them see how the patient is doing, how the current treatment plan is or isn't working, and what daily events or stressors might be bringing on panic attacks and other worrisome outcomes.

That's especially important in dealing with a behavioral health concern. Rakowski says that patients living with these health issues are still stigmatized and are less inclined to visit a doctor when they need one. They may also have difficulties opening up to a doctor about their mental health or describing what they're feeling or how they're acting.

"Just getting people to pick up their phone [and call] is a challenge," Rakowski says.

A digital therapeutic must not only be functional, but easy and attractive enough that someone will want to use it and continue using it when needed. A treatment like Freespira's fits that bill, while also helping patients become more comfortable with managing their health.

Rakowski says CCHP has plans to boost the number of members using the Freespira platform, and he's hoping the numbers continue to look good. They've had good and bad luck with digital health so far, but the success of both Freespira and Propeller Health is giving administrators ideas on what other treatments to try. They'd love to find an mHealth app, he says, that will help new and expectant mothers with maternity care.

"Implementation is time-consuming," he says, "but for us as a health plan, we see what we've done with this so far and the difference we're making. We're changing people's lives."