Mental health digital therapeutics boost outcomes at Froedtert & MCW

Mental health conditions are prevalent in the communities served by the Froedtert & the Medical College of Wisconsin Health Network, based in Milwaukee. However, they’re often unrecognized, under-addressed and under-treated – especially because of limited access to specialized mental healthcare.

THE PROBLEM

In 2017, a multidisciplinary team at the health network began building a digital formulary to offer evidence-based tools, driven by high-quality software, to prevent, manage or treat a spectrum of physical, mental and behavioral conditions. This focus on digital therapeutics aimed to expand access, enabling the health network’s patients to manage their mental health beyond traditional healthcare settings.

Given the complexity of mental health access challenges, digital tools offered an accessible, tech-enabled alternative, said Dr. Bradley Crotty, chief digital officer at Froedtert & MCW and interim president of Inception Health, the innovation arm of Froedtert & MCW.

“Such tools could either complement or supplement conventional therapy, giving patients the flexibility to work on mental wellness at their own pace and outside of typical office hours,” Crotty explained. “Digital tools, especially internet-based cognitive behavioral therapy (CBT), also presented a path to address broader behavioral health concerns, including anxiety, depression, insomnia, alcohol overuse and chronic pain management.

“Recognizing this potential, we identified a digital CBT program as a fitting solution to support both patients and clinicians, bridging gaps in access and offering timely, individualized care,” he added.

PROPOSAL

As the team began to assess options for digital CBT, Froedtert & MCW partnered with SilverCloud. SilverCloud provides education on CBT designed to help people develop skills to detect, challenge and then change their unhelpful thoughts, feelings or behaviors related to challenging situations, helping users improve both physical and mental health.

“This program allowed patients to be in charge of their mental health, giving them the access and tools they needed to increase their mental wellness,” Crotty noted. “SilverCloud also offers a digital health coaching component, allowing users to have a live person performing check-ins throughout their program, to improve accountability and outcomes.

“A digital system also can be integrated into provider workflows, making it accessible for ordering when patients express the need for mental healthcare,” he continued. “Because it could be integrated into our EHR, we could easily scale the program, getting it into the hands of anyone who would benefit.”

MEETING THE CHALLENGE

When SilverCloud launched at the health network, it immediately began to address some of the financial and scheduling concerns preventing patients from seeking relief.

“By offering the program at no cost to the patient, we were able to get resources into the hands of patients as soon as they told their providers there was a problem,” said Jay Burns, digital behavioral health coach at Froedtert & MCW. “Since SilverCloud is available on any smart device, people are able to work on it whenever their schedule allows.

“People with multiple jobs, busy parents and college students who had upcoming deadlines all had the freedom to log in at their convenience,” he added. “Customizing the program to patients’ needs was the philosophy we wanted to use moving forward.”

When a patient first creates their account, they are asked to share a list of goals with their coach. These goals then are used to help connect SilverCloud users with the readings most relevant to them.

“As time moved on, we saw the success of this philosophy and changed the registration process so patients pick which program to enroll in instead of their provider,” Burns explained. “This change allows patients to learn skills that will help with anxiety, depression, stress, insomnia, chronic pain, diabetes, alcohol use and ADHD symptoms, while avoiding the perceived stigma attached to any of those subjects.

“After using SilverCloud for six years, we acknowledged there was an opportunity to allow patients to self-enroll in the program,” he continued. “Patients may not know how to discuss their mental health needs or may not have time to bring them up during an already busy provider appointment. That is why we enabled patients to self-enroll in SilverCloud through the Froedtert & MCW mobile app.”

RESULTS

While mental health continues to be among the top health issues facing the health network’s communities, since launching the technology in 2017 more than 10,000 people have become members.

“Clinical improvement, measured by changes in PHQ-9 and GAD-7 scores for depression and anxiety, respectively, showed statistically significant reductions,” Burns reported. “Patients with at least moderate depression experienced an average 23% reduction in PHQ-9 scores, while those with at least moderate anxiety showed a 26% reduction in GAD-7 scores.

“These improvements were both clinically and statistically significant, affirming the efficacy of digital CBT in supporting mental health,” he added.

In addition to these clinical outcomes, Froedtert & MCW has the opportunity to see the user satisfaction data for patients.

“Since launching, our patients have reported a 92% satisfaction rate,” Burns stated. “This data asks users if what they learned was interesting, relevant, helpful and actionable. We also get the opportunity to hear from our patients.

“Our patients have re-learned how to drive after surviving car accidents, manage the grief of losing a spouse, or gain the confidence to leave a career that was not working for them,” he noted. “Our patient’s voices are what help us know that digital solutions really can make a difference.”

The health network has seen such great patient outcomes with the technology that it is working toward providing an uncoached, stress and resilience module available to community members who do not have a Froedtert & MCW provider.

“We look forward to providing all adults in our community with mental health resources to improve their mental and physical health,” Burns added.

ADVICE FOR OTHERS

Using a digital therapeutic tool can help patients get the right care they need, at the right time and in a manner that works best for them, Crotty said.

“It is important to complete a full market analysis when determining which tool to use, to ensure it’s the best tool and vendor for your organization and your patients,” he advised.

“Once you determine what digital therapeutic to use, it’s important to educate your care teams about the offering and to get it into the hands of as many patients as possible,” he concluded. “Multiple avenues of enrollment – manual orders, automated orders and self-enrollment – can make the program a success.”

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