Case Study: Innovative Reimbursement Strategy for Digital Therapeutics
Case Study on Innovative Reimbursement Approaches from AppliedVR and MDIC
Chronic pain has a substantial economic impact on the United States, costing an estimated $635 billion annually. While VR has been studied and used in various acute and chronic pain conditions for decades, headset technology has only recently become simple to use and broadly accessible, and it continues to improve.
AppliedVR, a California-based company pioneering immersive virtual reality for medical therapeutic use, has achieved a remarkable feat, working with the Centers for Medicare & Medicaid Services (CMS) to include RelieVRx® in the existing benefit category for durable medical equipment (DME), the first immersive VR therapeutic to follow this strategy to tap into existing payment authority.
Home-based VR therapies like RelieVRx® hold the potential to broaden access to effective and on-demand nonpharmacologic treatments for chronic lower back pain that are durable well beyond the end of treatment. Understanding reimbursement as a combination of coding, coverage, and payment provides the context for the hurdles all new technologies must clear. Regulatory strategy may be under appreciated in terms of its influence on reimbursement success, and this was certainly key to the decisions related to code assignment and granting the benefit category as DME for RelieVRx®.
Understanding the intricacies of reimbursement codes and benefit categories is crucial for innovators seeking to navigate the evolving landscape of virtual reality in healthcare. It is essential to keep an eye on emerging trends and codes to make informed decisions and leverage opportunities for reimbursement in this rapidly evolving field. Founders of VR healthcare companies should vigilantly monitor the evolving reimbursement landscape and how changes may influence their business model. By capitalizing on these established reimbursement options and staying attuned to emerging trends, healthcare providers can harness the full potential of VR technology in delivering innovative and effective treatments.