In Milwaukee, mental health conditions are widespread within the communities served by the Froedtert & the Medical College of Wisconsin Health Network. Yet, these issues often go unrecognized, are inadequately addressed, and receive insufficient treatment. This is particularly due to limited access to specialized mental healthcare.

Expanding Access through Digital Therapeutics

In 2017, a multidisciplinary team at the health network initiated the construction of a digital formulary. Driven by high-quality software, this formulary offers evidence-based tools to prevent, manage, or treat a wide range of physical, mental, and behavioral conditions. The focus on digital therapeutics aimed to enhance access, enabling patients to manage their mental health beyond traditional healthcare settings.Dr. Bradley Crotty, chief digital officer at Froedtert & MCW and interim president of Inception Health, emphasized the complexity of mental health access challenges. Digital tools provided an accessible and tech-enabled alternative. "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," he 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.

Partnership with SilverCloud

As the team assessed options for digital CBT, Froedtert & MCW partnered with SilverCloud. SilverCloud offers 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. This helps 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 can be integrated into provider workflows, making it accessible for ordering when patients express the need for mental healthcare. Because it could be integrated into the EHR, the program can be easily scaled and made available to anyone who would benefit.

Addressing Financial and Scheduling Concerns

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, resources could be provided to those in need as soon as they expressed a problem. Since SilverCloud is available on any smart device, people can work on it whenever their schedule allows.People with multiple jobs, busy parents, and college students with upcoming deadlines all had the freedom to log in at their convenience. Customizing the program to patients' needs was the philosophy they wanted to follow. When a patient first creates their account, they are asked to share a list of goals with their coach. These goals are then used to help connect SilverCloud users with the readings most relevant to them.As time passed, the success of this philosophy led to a change in the registration process. Patients now pick which program to enroll in instead of their provider. This change allows patients to learn skills that will help with various issues while avoiding the perceived stigma attached to certain subjects.After using SilverCloud for six years, an opportunity arose to allow patients to self-enroll in the program. Patients may not know how to discuss their mental health needs or may not have time during a busy provider appointment. That's why they can now self-enroll in SilverCloud through the Froedtert & MCW mobile app.

Impressive Results

While mental health remains a top health issue for 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. 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.In addition to these clinical outcomes, Froedtert & MCW has the opportunity to see the user satisfaction data for patients. Since launching, their patients have reported a 92% satisfaction rate. This data asks users if what they learned was interesting, relevant, helpful, and actionable. The health network has also heard from patients who have re-learned how to drive after car accidents, managed the grief of losing a spouse, or gained the confidence to leave a career that wasn't working for them.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. 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. Once you determine what digital therapeutic to use, it's important to educate your care teams about the offering and get it into the hands of as many patients as possible. Multiple avenues of enrollment - manual orders, automated orders, and self-enrollment - can make the program a success.