Will Healthcare Technology Prove to Be a Failure of Imagination?

A failure of imagination describes an unfortunate historical event that was not inevitable. It could have been prevented had it been imagined or predicted, which seems reasonable in retrospect. This is one analysis of 9/11. Clarity appears with hindsight, and experts conclude, too late, it should have been anticipated. It is well known that prevailing views can blind us. Assumptions can act like blinders.

Where might we find a candidate for such a failure? Healthcare technology is a bold contender. Telehealth, digital health, and virtual health are ubiquitous today. Healthcare investors think they have a big winner. Do they, or are they betting on the next big healthcare disappointment? We have all the evidence needed to argue for and against success, leaving everyone to make their own predictions.

The concern is not the technology itself. It is how we use it. The 2 leading healthcare adopters of this technology are behavioral and primary care. The pivotal question is how these products and services fit into our existing delivery system. Are they ancillary or first line services? Do they replace existing services? When combining digital and personal care, do we have the right balance?

Behavioral healthcare has seen the rise of digital solutions over the past decade, and startup companies are now part of multi-billion-dollar entities. For example, myStrength is now part of the NYSE-traded company Teladoc, which offers “whole-person virtual care” for mental health, chronic conditions, and the full spectrum of primary care problems. These are made available through payers like health plans.

Virtual is a more convenient and possibly less expensive product. In-person contact is not essential for every behavioral health or primary care visit. Which visits should be virtual? What about the initial clinical assessment? These products are now being sold as the point of first contact for care under the rubric of “virtual-first” or “digital-first” health benefits. Every health plan is rushing to offer this benefit.

National health plans like United, Aetna, and Humana introduced virtual-first primary care plans in 2021, as did smaller regional carriers. They may work with companies like Teladoc or MDLive for a provider network that can be virtual. The term virtual-first fits different benefit designs since plans mix in-person and virtual services in various ways. Virtual as the first primary care contact is the main idea.

Digital-first benefits for behavioral health may seem less controversial. We have a very wide access gap for people with every type and severity of behavioral problem. Isn’t digital care better than nothing? It seems more worrying that a primary care assessment lacks a hands-on component. Yet digital products for behavioral care have their own special problems. Consider prescription digital therapeutics.

Pear Therapeutics promotes itself as a pharmaceutical company even though its FDA-approved products are not biological agents. It sells digital cognitive-behavioral tools for addiction recovery. Happify Health plans to follow its lead by expanding from tools for mental health to therapeutics for migraines. They too expect FDA approval for these tools. These products are all available by prescription only.

While one might question the peculiar logic for restricting common CBT-based tools to a prescription, the bigger concern is the failure to understand decades of research. CBT is effective, yet no more so than other established therapies. More to the point, the larger driver of results is the therapist providing care, not the specific therapeutic ingredients (be they CBT or some other model).

Investors are unconcerned. They are ready to discount worries that a virtual assessment might miss clinical issues that an in-person visit would detect. Worries about product cannibalism can be dismissed as well. If young and healthy patients love these cheaper, virtual products, sales will soar. Investors will gladly leave concerns to someone else about cannibalizing traditional benefits or undermining PCP care.

There are many positive features of health technology. Negative expectations may be misguided. The real failure of imagination may prove to be hesitancy about launching broad scale implementations. However, until we know for sure, we need meaningful debate. Acquiescence to the latest big money idea is ill-advised. A failure of imagination is essentially a refusal to seriously consider all possibilities.

Will virtual-first ultimately join the ranks of bitter health insurance memories? Will we have flashbacks to the dot-com bubble? We may end up concluding once again that the best of healthcare starts from healing relationships, and digitizing guidelines or making clinicians remote diminishes effectiveness.

It is also possible technology products will improve access to care, provide much of what patients need, and create valuable new treatment modalities. Technology can simplify, extend, and advance care, while it can also produce shiny new objects that distract us. We need our minds open and active.

Ed Jones, PhD, is currently with ERJ Consulting, LLC and previously served as President at ValueOptions and Chief Clinical Officer at PacifiCare Behavioral Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.