One of digital therapeutics' greatest strengths is its accessibility and connectivity, not only providing access where previously unable but going further to connect areas of healthcare traditionally disjointed, allowing for more comprehensive, holistic treatment plans that more effectively serve the granular, often interwoven needs of patients suffering with chronic or complex illnesses. 

Thanks to the bevy of ineffectual, often pseudoscientific apps that have flooded the digital health market for most of its short life, emerging DTx products are held to exceptionally high standards by regulatory agencies and key consumers. While those like the FDA have implemented stringent testing requirements to combat misinformation and malpractice, prospective stakeholders often carry a level of apprehension towards digital applications that must be overcome to secure opportunities and achieve adoption. Because of this, developers of DTx solutions must maintain a laser-like focus on the specific clinical conditions and stakeholders they intend to serve. 

Yet, this necessity has an unfortunate side effect: many DTx go-to-market strategies fail to address the full scope of the healthcare ecosystem and its importance in creating a compelling, end-to-end user experience that promotes and fuels success. 

Beyond the patients and physicians, at the core of any digital application is a vast network of individuals, organizations, and services involved in numerous aspects of healthcare, from financial support to data aggregation. Engaging with these auxiliary stakeholders is critical to creating the differentiation needed to rise above the throngs of unsubstantiated competitors. The most successful DTx go-to-market strategies contain a carefully considered roadmap to development and market entry that defines key value propositions with stakeholders in all aspects of condition management. 

Stakeholders of the DTx Ecosystem 

Two primary groups exist in the ecosystem of stakeholders surrounding any DTx solution: transactional and influencer stakeholders. 

Often the focus of development efforts, transactional stakeholders are those that form the nucleus of the ecosystem, providing essential services and information. These include:

• Patients and Caregivers for whom the solution has been developed.
• Payers and PBMs who are decision-makers for DTx reimbursements typically having input for developers related to data and analytics.
• Providers who drive patients' decision-making when managing treatment options and are particularly important in promoting adoption.
• Pharmaceutical and MedTech: Primary paying customers for DTx solutions and gatekeepers for widespread adoption. 

Influencer stakeholders are those whose services or involvement may be pivotal to success due to their ability to bolster awareness, attract adoption, improve usability, fuel engagement, and more. These stakeholders are often overlooked in DTx go-to-market strategies and yet hold the key to a truly effective ecosystem. They include:

• Care navigation and advocacy services who support critical non-clinical services such as patient benefit consulting.
• Clinical claims data aggregators and health IT organizations who provide critical input on data and analytics.
• The research community that influences clinical thought and shapes thought leadership through patient and provider networks, as well as directing market awareness.
• Digital health platforms who are involved in medical cost management. 

For organizations behind DTx solutions, the resources offered by these stakeholders can accelerate development and constitute an important component of success in the market, both upon entry and beyond. Thus, identifying those most relevant to the unmet needs at hand, defining the critical value exchanges that must occur, and incorporating them as an integral part of the solution and its ecosystem should be of utmost priority.

Defining Key Value Propositions

Demonstrating a comprehensive understanding of the give-to-get value exchanges within a DTx ecosystem allows organizations to set themselves and their products apart as high-quality, viable healthcare solutions. The "give" value refers to what the digital application offers to the stakeholder. In contrast, the "get" value refers to the information, services, and other benefits the DTx organization receives as a result of the interaction. 

Among transactional stakeholders: 

• The patient and caregiver group's "give" value includes improved access to information and high-quality care, along with capabilities that allow for personalized, comprehensive, on-demand management of conditions and their related health factors. Their "get" value, meanwhile, is a valuable insight into methods of managing and implementing therapies and data related to adherence useful in drug and device planning. 
• The Payers and PBM group has a "give" value of lower costs in care management and labor as related to patient treatment and adherence, ultimately supporting better clinical outcomes for health and wellness overall. Their "get" value includes information regarding insurance reimbursement payments and offering access to large populations of users and disease management organizations, both of which can be leveraged to promote adoption.
• Providers' "give" value is enhanced communication between patients and providers, particularly as tied to medical histories. In contrast, their "get" value is the identification of specific patients making ideal candidates for the DTx platform in question.
• The Pharma and Medtech group holds a "give" value of more informed future development and roadmap creation through access to insights into patient experience. Often, it also includes improved patient engagement with clinical trials. Meanwhile, their "get" value is the support of co-development, funding, and investment. 

Beyond these, among influencer stakeholders:

• The Care Navigation and Advocacy Services group has a "give" value of more widely accessible targeted clinical solutions and informational services that directly address the needs of patients to improve outcomes. Their "get" value is increased awareness, adoption, and engagement among patients and consumers.
• Clinical Claims Data Aggregators and Health IT Organizations hold a "give" value of revenue through licensing fees and other sources, as well as data and insight related to patient comorbidities and behaviors. The "get" value they offer is access to clinical workflows and real-time data capture, otherwise inaccessible.
• The Research Community's "give" value is in offering anonymous, aggregated clinical and behavioral data. Their "get" value is gaining access to research and clinical specialists helpful in development and principal investigators to conduct clinical trials. 
• Finally, Digital Health Platforms' "give" value is a broader, deeper base of clinical information and data, resulting in improved analysis and therapy insights related to condition management. Their "get" value lies in offering access to patients for greater adoption and awareness, alongside expanded insights into comorbidities and behaviors. 

With each DTx solution highly unique, the organizations behind them must consider these critical value exchanges not just during development and planning but through product launch and market entry. These targeted value propositions will fuel the viability and feasibility of solutions and allow for the creation of an ideal end-user experience. Further, partnerships between influencer stakeholders and DTx organizations help communicate their digital applications' quality and scientific backing. 

Common Elements for Success

Because each DTx application is so unique from the next, it can be challenging to give widely practical advice to organizations and developers just setting out. Still, MIDI's experience in the digital health arena has given us some insight into the common features of those that reach success. Ultimately, there are three common elements to every successful DTx solution:

• Meaningful interactions: With the targeted consumer audience of digital health solutions fatigued as they are, companies must offer attractive incentives for interaction to compel users into engagement and adoption. Value-added, innovative features set DTx applications apart from competitors and can act as powerful tools for altering behaviors. One example is gamification or gameplay elements such as progression and achievements to improve motivation, encourage adherence, and promote positive outcomes. Features such as this have been featured and found success in applications for several conditions, including diabetes, arthritis, back pain, obesity, and more. 
• Human-centered design: Organizations behind digital therapeutics must perform continuous user research to ensure that their solutions fit the needs of patients and providers as closely as possible. Poor usability design is a strong contributor to poor adherence and lower satisfaction. Comprehensive testing throughout development is the singular method of ensuring the most effective product-market fit.
• Workflow integration: It is critically important that DTx solutions are thoughtfully integrated into clinicians' regular workflow without requiring additional steps or presenting interruptions. Further, input information must be able to integrate seamlessly with existing patient information records. The most successful solutions eliminate inefficiencies and reduce required labor in clinicians' daily routines while requiring little to no change in infrastructure or systems. 

Poised to become the ushers of the next generation of healthcare services, digital therapeutics are expanding their reach further than ever, delivering evidence-based clinical care to patients in locations and circumstances unlike ever before. As these revolutionary products shift the disease management paradigm for the sufferers of chronic, complex illnesses and the providers who treat them, they are likewise shifting the positions and actions of the regulators, payers, and additional parties that fuel and maintain the healthcare market. By partnering with stakeholders in all arenas, developers of DTx applications can ensure they are providing effective solutions that will be accepted and appreciated by the patients who need them.