The missing pieces of the digital therapeutics puzzle

When it comes to marketing digital therapeutics, companies can only do so much on their own until certain information infrastructure is in place, Kristin Milburn, managing director of Healthware Labs, tells pharmaphorum Deep Dive.

Over the last few years, digital therapeutics have made great strides in efficacy, regulatory approval, and even reimbursement. But the most effective digital therapeutic in the world does nothing if a patient doesn’t know it exists, or a doctor doesn’t know they can prescribe it.

For marketing and communications around digital therapeutics today, awareness is the watchword – pharma marketeers have to get the word out about not only their particular product, but often about the whole category of digital therapeutics.

“I would say one of the biggest challenges, assuming that there’s a reimbursement pathway and you can get paid, is just awareness of these solutions,” Kristin Milburn, managing director of Healthware Labs, says. “And I do think that there needs to be an industry-wide effort to help educate both patients – and maybe physicians even more to start – about what are DTx and what is available in their therapeutic area. Because until they are aware of them, they’re never going to recommend them, obviously, to their patients.”

Healthware Labs partners with digital health start-ups and pharma companies to encourage digital innovation in healthcare. Milburn says the need to educate around digital therapeutics isn’t something that should take pharma by surprise.

“If you think about it, pharma spends a ton of money – and have since medicines were first developed – in doing market shaping and educating around specific new treatment modalities. This is no different. You can’t expect to create an entirely new category of solutions without educating broadly around what those kinds of solutions are.”

Still, though there may be similarities between traditional and digital therapeutics, it’s the differences that create difficulty for marketing and communications around DTx – and it will take the introduction of new sales infrastructure to fully address those challenges.

Educating the physicians

As the primary prescribers, doctors are the first group that needs to be educated about digital therapeutics, and at the moment, that doesn’t generally happen in formal medical education, Milburn says.

For now, pharma has to rely on the same channels it has always used to teach doctors about new therapies: a combination of key opinion leader education, digital channels, and sales reps. Though, Milburn notes, that paradigm is changing right now, even for drugs, so it likely won’t look like the traditional sales force model.

There’s a more pressing issue when it comes to physician education, however. Just as the user experience for patients needs to be easy for them to adopt, doctors will be more likely to prescribe something if that process is made as simple as possible – which can present a challenge for digital therapeutics.

“The doctors need to know about it,” Milburn says. “They need to be able even to prescribe it. So, there needs to be some kind of integration into their workflow. And that’s an area where I think there needs to be some work to develop either platforms where DTx can be distributed, or integrated within EHRs. But this notion of ‘if you build it, they will come’, as we all know – that’s not true.”

In addition to a simple workflow for prescription, Milburn says doctors need a simple way to survey the landscape of available digital therapeutics.

“How are they supposed to find out about them? Is there going to be some central place where they can look at all DTx and compare them against each other? Is it just finding out about it from their networks? I think there’s no kind of standardised way for physicians to learn about this new class of therapeutics.”

Reaching out to patients

Digital therapeutics marketeers need to target two audiences with awareness campaigns: physicians and patients. These efforts need to be differentiated, but can’t be undertaken in siloes from one another.

“You need to educate doctors, but then, once you educate the doctors, and you start to prescribe, then the patients themselves need to understand how to use the product,” she says. “The doctor’s not going to be there to hold their hand and show them how to use this new thing. There’s going to need to be some support on that side of things to ensure that they use it and that there’s engagement with the product.”

Even when selling into large groups, Milburn says, it’s going to be important not to take adoption for granted.

“In the case of when it’s sold into a payer or an employer, you might sell in a contract with an employer or a payer, but it doesn’t automatically mean that you’re going to have users,” she says. “You have to do the work of getting the adoption and getting people to download it, getting people to use it.”

Some of this work must be done on the front end as the digital therapeutic is developed; development needs to happen with the input of patients and an eye toward usability. Several of the most promising digital therapeutics today have an engaging form factor as a major selling point. Milburn used the example of Akili Therapeutics, which has developed a DTx for children with ADHD that takes the form of a video game.

“In the case of Akili, when they’re dealing with kids especially, we all know that kids love to play games,” Milburn said. “So, if you could deliver a clinically meaningful solution in the form of a game, presumably the adoption would be much higher than telling them they have to go read a book or something else that kids might not be as engaged with.”

Digital therapeutics and the patient journey

Another aspect of securing patient buy-in is for doctors to engage the patient at the right point in their journey, which involves DTx makers thinking hard about when that is for their particular intervention.

“When would be the appropriate time for a conversation about leveraging a specific DTx?” Milburn asks. “Is it right when they find out they have the disease? Is it after they’ve used other things? I mean, I tend to believe that DTx are going to eventually become kind of first-line therapeutics.”

Milburn sees DTx as first-line treatments in many cases because of their safety profile relative to drugs, as well as their scalability in cost and logistics of implementation.

One area where DTx might see strong traction is in conjunction with telemedicine, where the appeal is high for a therapy that can be delivered remotely. Another is around chronic conditions – a good example of the value of DTx as front-line treatments.

“I believe that DTx will probably be extremely helpful for chronic conditions that have a behavioral aspect to them, where we know different lifestyle interventions can really help these patients before they need to be on a drug. So that’s why we saw so much activity around diabetes. I think we’ll see more and more around cardiology and things like that.”

Building the future of DTx

Whatever the future has in store for digital therapeutics, if they’re to be widely understood, prescribed, and used, then the industry as a whole will need to step up to create the infrastructure to enable that adoption.

That will include better baseline education for physicians around DTx, established workflows for DTx prescription; established workflows for DTx prescription, and some kind of digital formularies to help make physicians aware of the DTx options available and their efficacy. On the patient side, it will require early attention paid to user experience and patient centricity to ensure that patients not only start using a therapeutic, but that they can have the sustained engagement necessary for therapeutic benefit.

In the meantime, the best thing pharma companies and DTx start-ups can do is focus on the fundamentals of good marketing and communication.

Kristin Milburn, Managing Director, Healthware Labs

A twenty+ year veteran of digital consulting, Kristin Milburn’s experience has had a consistent focus on healthcare, technology, and the intersection of the two. She is a strategic and innovative thinker, who has held leadership roles in strategy/planning and client engagement at various digital firms with numerous Fortune 100 pharmaceutical and technology clients. After launching her own digital shop and rising through the ranks on the agency side, Kristin jumped to the client side and joined the Digital Medicines team at Novartis for several years. Looking to gain experience on the start-up side, she then joined the digital mental health start-up called Headspace, helping integrate meditation and mindfulness into healthcare. Kristin is now the managing director of Healthware Labs, the digital health innovation consultancy of Healthware Group.

Jonah Comstock, Editor-in-Chief

Jonah Comstock is a veteran health tech and digital health reporter. In addition to covering the industry for nearly a decade through articles and podcasts, he is also an oft-seen face at digital health events and on digital health Twitter.

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