Beyond the tragic death toll of the COVID-19 pandemic, the global health crisis has also caused other significant issues that affect one’s health and wellbeing. According to one recent article in Psychiatric Times, “the pandemic has triggered significant emotional, physical, and economic problems around the world.” The physician authors of that piece went on to note, “The emerging literature measures the impact of various traumatic stressors related to COVID-19, as well as the effects of less severe types of stress exposures. COVID-19 has already led to diverse mental health problems, including anxiety, depression, post-traumatic stress disorder [PTSD], and other trauma- and stress-related disorders.”
Indeed, during the pandemic, more than 40 percent of adults in the U.S. have reported symptoms of anxiety or depressive disorder, a share that has been largely consistent, up from just one in ten adults who reported these symptoms from January to June 2019, data from a recent Kaiser Family Foundation (KFF) poll found. Across the healthcare ecosystem, stakeholders are taking action to respond to this substantial increase of behavioral health issues brought on by COVID-19. One such organization is Highmark, an independent licensee of the Blue Cross Blue Shield Association that covers the insurance needs of more than 5.6 million members in Pennsylvania, Delaware, and West Virginia.
Earlier this month, Highmark officials announced they would be expanding access to Freespira, a digital therapeutic for panic disorder and post-traumatic stress disorder, across its membership. Executives at the Kirkland, Wash.-based Freespira, Inc. assert its product is the only FDA-cleared digital therapeutic proven to significantly reduce or eliminate symptoms of panic attacks, panic disorder, and PTSD in just 28 days by training users to normalize respiratory irregularities.
Freespira, officials explain, is an at-home, medication-free, one-month treatment that addresses the underlying physiological causes of panic: chronic hyperventilation and/or other dysfunctional respiratory patterns. Though they may not always realize it, many people experiencing panic attacks breathe differently than others, and not only during a panic attack. Freespira teaches them to adjust their exhaled carbon dioxide (CO2) level and breathing rhythm to normal patterns. Doing so helps reduce or eliminate panic symptoms and panic attacks, sometimes in as little as two weeks, Freespira says.
With an authorization from their network physician or behavioral health specialist, Highmark members will receive a tablet computer containing the Freespira app. Members also get a sensor that measures their breathing rate and exhaled CO2 level. The sensor transmits data on the user’s breathing to the Freespira app, and real-time breathing information is then displayed on the tablet. What’s more, the patient receives personalized guidance in addition to visual and audio instructions on how to adjust his or her breathing. Members complete two 17-minute sessions each day for four consecutive weeks in their own homes, officials explain.
Although behavioral health issues have clearly increased during the crisis, Highmark leaders became interested in the program well before the pandemic. They initially piloted Freespira in 2016 as part of a VITAL Innovation program to help members suffering from panic disorder obtain relief with a new treatment option. In one study last year conducted at the Allegheny Health Network in Pittsburgh, researchers found that 86 percent of patients were symptom-free immediately post-treatment and 73 percent were still symptom-free 12 months post treatment. The study also led to significant cost savings for Highmark Blue Cross Blue Shield. The reduced costs included a 65 percent reduction in emergency department costs, a 68 percent reduction in pharmacy costs; and a 35 percent reduction in total medical costs—equivalent to a cost savings of $190 per member per month—the health plan’s officials touted.
Demetrios C. Marousis, director of behavioral health at Highmark, says Highmark is “pleased with the clinical and financial outcomes achieved for our health plan members through the use of Freespira,” calling it a “breakthrough, drug-free treatment that has reduced the impact of symptoms associated with panic attacks, resulting in reduced use of medications and other healthcare costs for symptom management.”
In a recent interview, Marousis says that following the successful pilot study, Highmark opted to make the device much more widely available across its membership base. At the same time, access was still somewhat restricted in that usage required several steps to take place. First, a Highmark member had to be in contact with a network provider who was aware of Freespira, who was trained in the use of the device, and who could then match that clinical need of that patient to Freespira, he explains. And the member, of course, had to be agreeable himself or herself. If all those boxes were checked, the member would get the device, receive weekly coaching, and then return the device after four weeks. Marousis recounts that by the spring of 2018, members who were interested in this program began to significantly ramp up. That led to an expansion of the treatment program in 2019 to include PTSD following FDA approval.
Then, once the pandemic began to unfold in 2020, Highmark added adding telehealth coaching to its commercial beneficiaries in Pennsylvania, Delaware, and West Virginia. The expansion of the partnership will also include the addition of remote coaching on the use of the Freespira device for members not connected to a trained behavioral health professional. This distinction is important, notes Dean Sawyer, president and CEO at Freespira, Inc., as data shows that only a small portion of panic disorder patients are actually in active therapy. “We have seen studies showing as few as 8 percent of patients suffering from panic disorder are in active behavioral health therapy. So if we’re only limiting this to those [people] that are seeing the behavioral health therapist, you are missing a large percentage of potential patients who can be treated,” he says.
To help fill that gap, Sawyer says that for newer customers, a claims analysis is done using an artificial intelligence (AI) tool that “essentially looks for utilization patterns with patients who have a diagnosis of panic disorder, PTSD, or have undiagnosed panic disorder. There are about 3 to 10 times more patients who have undiagnosed panic disorder compared to a formal panic disorder diagnosis, because most of those patients think they are having a medical issue such as a heart attack, and then show up in the ED. By using this AI tool, we're able to identify those patients who have high utilization around their conditions and who would appear to clinically benefit from the treatment, [while] also saving money back to the health plan,” he says.
