What is the problem?

Growing investment in digital health has expanded access to behavioral health care providers— for some. Many new digital offerings are designed to meet the needs of low-acuity patients, leaving out the patients who already face the greatest access barriers. Additionally, the draw of remote work for clinicians can further limit the availability of in-person appointments, which are essential for high-acuity care.

What can digital health organizations do?

Digital health organizations can improve patients’ access to the right providers by ensuring their offerings easily fit into clinician workflows and designing tools to better support high-acuity needs. In addition to the steps below, digital health organizations that employ clinicians and offer direct patient care should consult our accompanying playbook on how provider organizations can build a stronger behavioral health system.

1. Design digital platforms that make clinicians’ workflows smoother, reducing administrative burden and long-term burnout.

Many behavioral health providers face high caseloads with poor reimbursement, emotionally taxing jobs, and high levels of administrative burden. Organizations that develop digital tools oriented toward provider usage can improve provider workflows.

a) Incorporate usability testing with clinical professionals. Partner with provider groups early and often throughout product development to iterate on new platforms and tools.

b) Ensure that platforms can integrate easily with provider organization’s existing systems and workflows. Build out platforms that integrate with one or several top administrative systems used by your client base, and pilot test in different integrations to ensure smooth adoption.

c) Consider incorporating new digital technologies to streamline provider processes, rather than simply replicating in-person processes with digital tools. Collaborate with providers to look for opportunities to use technology to reduce administrative burden on providers and support more efficient workflow. Examples include integrated tools such as ambient listening to transcribe and automate appointment notes or tools to improve patient intake and scheduling.

2. Maximize your platform’s ability to serve high-acuity patients.

Not every digital behavioral health tool needs to (or feasibly can) directly serve high-acuity needs. But all patient-facing platforms should be prepared to interact with patients who are complex and/or in crisis and support them as best they can. Partner with clinical experts and patient advocacy groups to identify which high-acuity services you can offer digitally, which you can refer patients out to, and which are out-of-scope to incorporate into a digital platform in any way.

a) Embed an intake process to direct patients to the appropriate level of care within the platform. Directing low-acuity patients to lower levels of support protects more resource-intensive supports for those with higher-acuity needs. Establishing a triage process can also help identify any high-acuity patients who truly cannot be supported through the digital platform’s offerings.

b) Hardwire connections to support resources that fall outside of the digital platform. Patients with high-acuity needs will likely require additional support beyond what digital services can offer. The fragmentation of services can lead to patients falling through the cracks. Intentionally counteract this risk by hardwiring connection points, including directing patients to relevant outside resources, facilitating warm handoffs, and making information stores in the digital platform easy to download and share with a patient’s other providers.

What is the problem?

Adverse social determinants of health lead to—and exacerbate—behavioral health conditions. Because SDOHs impact up to 50% of a patient’s health outcomes, digital health organizations must incorporate meeting patients’ SDOH needs as a core part of their strategy. Digital health organizations should give special attention to addressing gaps in technology access and digital literacy.

What can digital health organizations do?

Digital health organizations have a unique role to play by designing their tools with equitable principles in mind, integrating social support directly into their platforms, and collaborating with community partners to address local barriers to accessing digital tools.

1. Design with digital equity in mind to ensure all patients can access and use the platform.

a) Utilize design features that are accessible or adaptable for all people, regardless of language, connectivity, disability, or other factors. Intentional design can reduce barriers due to poor connectivity and inaccessible end-user experiences. Digital platforms should consider expanding technical access by designing software that is compatible with older devices or that can be downloaded and used offline. Adding features such as audio-only options and services in multiple languages can help a broader patient population to seek care through digital services.

b) Adapt usage metrics to reflect the expansion in how your tools will be used after improving accessibility. When universal design features are adopted, the standard usage metrics may not line up with the true frequency of utilization. For example, if a service is adapted to be used offline, the number of downloads may indicate how many people are utilizing a service, different from the metrics that are collected when the platform is always connected online.

For more information on digital equity, see our publications Addressing digital inequity is a business imperative and Advancing Digital Equity Through Literacy and Design.

2. Integrate local resources for peer support and social services into the platform.

The convenience and mobility of digital interventions presents an opportunity for these platforms to play a role in connecting users to support for other needs that cannot be addressed in a digital context. One way to do this is by embedding pathways in the digital platform to connect users to resources for housing, food, and clothing in their local area, or link to a preexisting resource library.

3. Partner with local provider and community organizations to address barriers to using digital health tools.

Pair policy advocacy efforts with targeted partnerships to invest directly into communities. Examples include partnering with local organizations to directly give away devices or vouchers for internet services, partnering with community centers to offer digital literacy education, and investing in public libraries or other community spaces to designate safe spaces for community members to use digital health tools.

a) Identify a community organization recipient. This community organization should already focus on and have relationships with an identified priority population facing barriers to using digital health tools.

b) Collaborate to establish sponsorship and determine the best way for an initiative to move forward. Stakeholder organizations may be able to drive these initiatives alone or may use them as an opportunity to collaborate with other traditional stakeholders in a shared community. Designing an initiative from here is a product of collaboration between these partners.

What is the problem?

Though the sheer number of digital behavioral health tools have skyrocketed in recent years, the clinical evidence base has been slow to catch up. Since the efficacy of many of these digital tools remains uncertain, providers and consumers don’t know which platforms to prioritize, and payers are less willing to cover the costs of these tools.

What can digital health organizations do?

Digital health organizations can build the clinical evidence base for their tools by tracking, analyzing, and sharing meaningful patient outcomes data, stratified by demographic group. This can help the industry come to better consensus on defining recovery and quality care.

1. Track short- and long-term quality and cost outcomes, stratified by demographic group, to contribute to the industry-wide evidence base on effective treatments. Many digital platforms primarily track and report process or volume-based metrics, such as number of users. While this is a helpful starting point, digital health organizations should also:

a) Embed mechanisms within digital platforms to collect more data. Prioritize patient-reported outcomes and functional measures (such as employment status or ability to maintain relationships), which offer a stronger data set to assess impact.

b) Analyze data stratified by REGAL (race, ethnicity, gender and sexual orientation, age, language) to understand the effectiveness of interventions for different populations. Where marginalized groups experience worse outcomes, invest in adapting existing (or designing new) tools.

c) Share deidentified outcomes data with academic researchers and health plans to evaluate impact and improve care standards in behavioral health. Identify teams on both sides of these partnerships who will be responsible for establishing data-sharing processes. When sharing data, communicate important context and confounding variables to ensure the most accurate interpretation.

d) Educate clients on the timeline they can expect to see results. Partners and purchasers like health plans and employers are often eager to see quick results. When adopting a new digital health tool, you may see impressive results on volume metrics quite quickly, but it often takes longer to see impact on measures like health outcomes and costs—and this journey may not be linear. Help partners understand how they should think about the holistic value of a platform beyond volume metrics.

What is the problem?

Low-income patients may have trouble accessing digital tools and interventions since many organizations rely on a self-pay or employer-sponsored model. This is especially true for more specialized interventions such as digital therapeutics, where the cost to consumers can be prohibitively expensive.

What can digital health organizations do?

Digital health organizations can help reduce the cost burden of behavioral health care on patients by expanding payer partnerships and offering affordable purchasing options directly to consumers.

1. Collect feedback and data from consumers to identify disparities in the user base and analyze the extent to which cost is prohibitive to patient access, adherence, and effectiveness.

This includes analyzing the composition of the user base by income level and soliciting feedback from consumers who choose to reduce or stop using services.

2. Secure payer partnerships to expand coverage of effective digital health tools.

The most sustainable way to ensure access to digital tools is to negotiate coverage of digital services by payer organizations. Digital health organizations will need to leverage clinical outcomes data to encourage payers to cover these interventions and tools, as detailed previously.

In addition to clear outcomes data for your services, communicate early and often what your organization needs to serve plan members. For digital health organizations that employ clinicians, this could include including higher rates or reduced documentation requirements.

3. Consider instituting a sliding scale pricing model for individual consumers or purchaser partners who serve low-income populations.

Customized pricing models can differentiate your product in a crowded market and expand your client base. For example, health plans with multiple lines of business may prefer a one-stop-shop that can serve members across commercial, MA, and managed care plans.