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Billing Codes for DTx Would Open the Floodgates for Behavioral Health Equity

Approval of Medicare and Medicaid coverage for digital therapeutics represents next step in advancing care for mental health patients.


I’ve spent the last 25 years leading and scaling IT projects for major health plans. In that time, I’ve seen our healthcare system’s inadvertent inability to treat mental and behavioral health disorders as chronic conditions firsthand. Even with the most advanced technologies and treatment capabilities based upon proven and validated science at the ready, we are still unable to get mental and behavioral health care to the people who need it most.


Far too many people struggling with mental and behavioral health conditions are doing so outside of the healthcare system; nearly 1 in 3 are going without treatment, even in states with the greatest access to providers. We are developing the tools to address this problem.


Just ten years ago, only a handful of digital therapeutics (DTx) were able to demonstrate clinical efficacy as evidence-based, digitally-delivered treatments. The market has since grown, and today, DTx are advanced enough to be complementary to—and in some cases, viable substitutes for—many traditional clinical therapies. DTx solutions have emerged as powerful tools for managing chronic diseases, as alternatives to pharmacological therapies—which can have their own drawbacks and limitations—and as vehicles for delivering full-scale treatments for mental and behavioral health conditions.


Studies have shown DTx can be just as effective as many traditional therapies, specifically for mental and behavioral health disorders, and many can be used outside of a clinical setting—providing much-needed treatment to those sidelined by the worsening provider shortage.


This means a person struggling with major depressive disorder may soon access cognitive behavioral therapy through a VR headset—that is, if they have the financial means to afford a VR headset. And therein lies the rub. As is the question with any healthcare innovation, how can we ensure DTx is accessible to those who need it most?


The answer may lie in codifying reimbursement policies for Medicare and Medicaid beneficiaries.


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