Over the past two years, managed care organization Kaiser Permanente has been testing how to give its members access to digital health tools. The company picked six apps that it would cover for its members, and trained clinicians on how to include the use of digital health apps in their workflow.
One of the challenges is making these tools easy to find, and getting patients to use them. In a recently published paper in NEJM Catalyst, Kaiser found that patients were more likely to use health apps after being referred. So far, its clinicians have made 115,000 referrals.
“We think we’ve cracked the code and figured out how to get people to use these, in the context of treatment so that they might have their biggest effect,” Dr. Don Mordecai, national leader for mental health and wellness at Kaiser Permanente, said in a phone interview.
In early testing, a group of 562 clinicians in Kaiser’s mental heath and depression care programs referred 16,438 patients to mental health apps. Of that group, 58% downloaded an app, 40% used it at least once and 27% used an app more than three times.
Mordecai said digital health tools could serve as an adjunct to treatment, such as in between therapy sessions. Or, people could choose to access them on their own time.
Kaiser Permanente selected six apps for this program:
- Headspace, a popular meditation app that has raised more than $200 million to date
- Calm, another well-known sleep and meditation app that recently raised $75 million
- Whil, an app that offers courses on stress resilience and mindfulness for businesses
- Cognitive behavioral therapy app myStrength, which was acquired by Livongo last year
- SilverCloud, a startup that offers mental health programs paired with coaching. It has raised more than $26 million to date.
- Thrive, an app with cognitive behavioral therapy tools and mood tracking.
To narrow down the list of possibilities, Kaiser Permanente brought in hundreds of patients and clinicians to help assess and test these apps. It also considered whether they were based on clinical evidence and were HIPAA-compliant.
“Absolutely, issues like privacy came into the question,” Mordecai said. “There are apps out there where their business model is to gather and sell your data. That was of zero interest to us.”
There was also an emphasis on user experience — whether the apps were actually enjoyable and easy to use.
“We’ve been having conversations with digital companies for years, but I think it needed to reach a certain level of maturity,” Mordecai said. “The first round of these kinds of things, like computerized CBT, one of the reasons that people didn’t use them that much was that they were kind of clunky. … What we’ve seen over the past five years or so is a real evolution of these apps in terms of a compelling user experience and in terms of people’s willingness to engage with them.”
Building an ecosystem
Kaiser Permanente set out to begin building this digital health “ecosystem” in 2018. The idea was to build a platform where clinicians could refer patients to a curated portfolio of apps and document it in a patient’s health record. It began more broadly rolling this out to its members in 2020.
In recent years, the managed care organization has faced its own challenges with mental health treatment. Three year ago, Kaiser Permanente faced state sanctions after patients reported long wait times for mental health treatment. Last year, the company touted hiring more than 1,000 therapists, but mental health workers and patients said they still struggled with timely access to care.
The Covid-19 pandemic was expected to exacerbate existing problems with accessing mental healthcare across the U.S. Telehealth visits have helped bridge what would otherwise be drop-off in care, but still haven’t solved some of the root issues.
Initially, like other healthcare providers, Kaiser saw demand for visits drop as people sheltered in place, but it quickly recovered as more people turned to telehealth appointments.
“I think, in some sense, the wave is still coming,” Mordecai said. “I think we’re going to be grappling with the impact of this for a while after the virus threat is diminished.”
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